ACE-INHIBITOR RAMIPRIL IS MORE EFFECTIVE THAN THE BETA-BLOCKER ATENOLOL IN REDUCING LEFT-VENTRICULAR MASS IN HYPERTENSION - RESULTS OF THE RACE (RAMIPRIL CARDIOPROTECTIVE EVALUATION) STUDY

Objectives: To compare the effect of the angiotensin converting enzyme (ACE) inhibitor ramipril with that of the beta-blocker atenolol on re versal of left ventricular hypertrophy, on blood pressure and on other echocardiographic parameters. Design: The study was conducted in acco rd with the PROBE (prospective randomized open blinded endpoint) desig n. Randomized treatment either with ramipril or with atenolol was cont inued for 6 months, and echocardiograms were recorded before and after 3 and 6 months of treatment. The echo tracings were blindly evaluated in a single reading centre. Methods: M-mode, two-dimensional guided e chocardiography was used to measure left ventricular wall thicknesses and dimensions, from which left ventricular mass was calculated, accor ding to the Penn convention. Results: Of 193 patients at 16 centres, 1 11 had echocardiograms that could be quantitatively evaluated. The pri mary analysis of the study was performed using data from those patient s. In addition, echocardiograms of 88 patients were analysed on an 'ac cording to protocol' basis (patients with preset values of left ventri cular mass). Systolic and diastolic blood pressures were significantly reduced both by ramipril and by atenolol without any significant diff erence between the two drug treatments. The heart rate was significant ly reduced by atenolol only. Both the 'primary' and the 'according to protocol' analyses showed that the left ventricular mass was significa ntly reduced by ramipril only. Comparison between treatments according to a multivariate analysis demonstrated a significantly greater reduc tion in left ventricular mass during ramipril than during atenolol tre atment. Conclusions: The present study is the first of suitably large size in which a direct comparison of the effects of an ACE inhibitor a nd a beta-blocker on echocardiographic left ventricular mass has been performed. It has demonstrated that ramipril is more effective than at enolol in reversing left ventricular hypertrophy in essential hyperten sive patients.