Reversal of Left Ventricular Hypertrophy

Fagard, Robert

doi:10.1001/jama.1996.03540200022019

Cited by 4 publications

(3 citation statements)

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“…However, this metaanalysis was criticized because each treatment arm of the double-blind, randomized, controlled clinical trials was taken as a separate observation without respect for the original comparative design. 6 In a more recent meta-analysis of 5 drug classes, 4 the same group reported that, when each treatment arm was taken as a separate observation, there were significant differences in the reduction of LVM among the 5 drug classes (Pϭ0.004). LVM decreased by 13% with angiotensin receptor blockers, by 11% with calcium channel blockers, by 10% with ACE inhibitors, by 8% with diuretics, and by 6% with ␤-blockers.…”

Section: Fagard Et Al Drugs and Regression Of Left Ventricular Massmentioning

confidence: 99%

“…1,2 A subsequent meta-analysis 3 only included studies that compared different drug classes in randomized designs, but this meta-analysis was criticized, because the results were reported separately for the different drug classes, without respect for the original pairwise design. 6 An earlier meta-analysis of prospective, comparative, randomized studies in which Ն2 classes of drugs were compared, including diuretics, ␤-blockers, calcium channel blockers, and ACE inhibitors, found no differences in the regression of LVM in pairwise comparisons of each class versus the other 3 classes statistically combined. 7 However, the number of eligible studies was small at that time, limiting pairwise comparisons between 2 drug classes, 7 but has since considerably increased and now also includes studies involving angiotensin receptor blockers.…”

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Regression of Left Ventricular Mass by Antihypertensive Treatment

et al. 2009

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Abstract-Blood pressure-lowering therapy reduces left ventricular mass, but the question of whether differences exist among drug classes has not been fully resolved. Our aim was to compare the effects of diuretics, ␤-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers on left ventricular mass regression in patients with hypertension on the basis of prospective, randomized comparative studies. We performed meta-analyses, involving pooled pairwise comparisons of the drug classes and of each class versus other classes statistically combined, and meta-regression analyses to identify the determinants of the regression. The 75 relevant publications involved 84 pairwise comparisons and 6001 patients. Regression of left ventricular mass was significantly less (Pϭ0.01) with ␤-blockers (9.8%) than with angiotensin receptor blockers (12.5%), but none of the other analyzable pairwise comparisons between drug classes revealed significant differences (PϾ0.10). In addition, ␤-blockers showed less regression than the other 4 classes statistically combined (PϽ0.01), and regression was more pronounced with angiotensin receptor blockers versus the others (PϽ0.01). In multivariable meta-regression analysis on all of the treatment arms, ␤-blocker treatment was a significant and negative predictor of the regression (Ϫ3.6%; PϽ0.01), but this was not the case for the other drug classes, including angiotensin receptor blockers. In conclusion, ␤-blockers show less regression of left ventricular mass, whereas angiotensin receptor blockers may induce larger regression. The inferiority of ␤-blockers appears to be more convincing than the superiority of angiotensin receptor blockers. Key Words: angiotensin-converting enzyme inhibitor Ⅲ angiotensin receptor blocker Ⅲ ␤-blocker Ⅲ calcium channel blocker Ⅲ diuretic Ⅲ left ventricular mass Ⅲ meta-analysis T here is little doubt that blood pressure (BP)-lowering therapy reduces left ventricular (LV) mass (LVM) in patients with hypertension in comparison with placebo treatment. 1-3 However, the question of whether differences exist among drug classes remains a matter of debate. Meta-analyses have suggested that angiotensin-converting enzyme (ACE) inhibitors might be more effective than other first-line therapies 1,2 ; that ACE inhibitors and, to a lesser extent, calcium channel blockers, rather than diuretics and ␤-blockers, emerge as first-line candidates to reduce LVM 3 ; and, more recently, that angiotensin receptor blockers also favorably reduce LVM. 4 Advantages of the meta-analytic technique are the increased statistical power and the more accurate estimate of the magnitude of the effect, 5 but the results largely depend on the criteria for the inclusion of studies. In early meta-analyses on the regression of LVM, the majority of the included studies were open, uncontrolled, single-drug studies, which may seriously hamper their interpretation. 1,2 A subsequent meta-analysis 3 only included studies that compared different drug classe...

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Section: Fagard Et Al Drugs and Regression Of Left Ventricular Massmentioning

confidence: 99%

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confidence: 99%

Regression of Left Ventricular Mass by Antihypertensive Treatment

et al. 2009

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“…HF has emerged as the single leading diagnosis for hospitalization in the elderly and hospitalization rates are higher among blacks than among whites, with 83% of HF patients hospitalized at least once and 43% hospitalized at least 4 times over a mean duration of 4.7 years . The burden of HF is likely to increase because of the increasing age of the American population, earlier age of onset of HF and improved treatment and survival from cardiovascular (CV) diseases, including myocardial infarction (MI) and hypertension …”

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confidence: 99%

Carotid Intima‐Media Thickness is Associated With Incident Heart Failure Among Middle‐Aged Whites and Blacks: The Atherosclerosis Risk in Communities Study

Effoe

Rodríguez

Wagenknecht

et al. 2014

JAHA

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BackgroundIncreased carotid intima‐media thickness (IMT) is associated with subclinical left ventricular myocardial dysfunction, suggesting a possible role of carotid IMT in heart failure (HF) risk determination.Methods and ResultsMean far wall carotid IMT, measured by B‐mode ultrasound, was available for 13 590 Atherosclerosis Risk in Communities study participants aged 45 to 64 years and free of HF at baseline. HF was defined using ICD‐9 428 and ICD‐10 I‐50 codes from hospitalization records and death certificates. The association between carotid IMT and incident HF was assessed using Cox proportional hazards analysis with models adjusted for demographic variables, major CVD risk factors, and interim CHD. There were 2008 incident HF cases over a median follow‐up of 20.6 years (8.1 cases per 1000 person‐years). Mean IMT was higher in those with HF than in those without (0.81 mm±0.23 versus 0.71 mm±0.17, P<0.001). Unadjusted rate of HF for the fourth compared with the first quartile of IMT was 15.4 versus 3.9 per 1000 person‐years; P<0.001. In multivariable analysis, after adjustment, each standard deviation increase in IMT was associated with incident HF (HR 1.20 [95% CI: 1.16 to 1.25]). After adjustment, the top quartile of IMT was associated with HF (HR 1.60 [95% CI: 1.37 to 1.87]). Results were similar across race and gender groups.ConclusionsIncreasing carotid IMT is associated with incident HF in middle‐aged whites and blacks, beyond risks explained by major CVD risk factors and CHD. This suggests that carotid IMT may be associated with HF through mechanisms different from myocardial ischemia or infarction.

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