REVERSAL OF LEFT-VENTRICULAR HYPERTROPHY IN ESSENTIAL-HYPERTENSION - A METAANALYSIS OF RANDOMIZED DOUBLE-BLIND STUDIES

Objective.-To determine the ability of various antihypertensive agents to reduce left ventricular hypertrophy, a strong, blood pressure-inde pendent cardiovascular risk factor, in persons with essential hyperten sion. Data Sources.-MEDLINE, DIMDI, RINGDOC, ADES, EMBASE, and review articles through July 1995 (English-language and full articles only). Study Selection.-Meta-analysis of all published articles including onl y double-blind, randomized, controlled clinical studies with parallel- group design. Data Extraction.-Intensive literature search and data ex traction according to a prefixed scheme performed independently by 2 i nvestigators. Reduction of left ventricular mass index after antihyper tensive therapy with placebos, diuretics, beta-blockers, calcium chann el blockers, or angiotensin-converting enzyme (ACE) inhibitors was the principal parameter. Data Synthesis.-Of 471 identified references des cribing the effects of antihypertensive drugs on left ventricular hype rtrophy, only 39 clinical trials fulfilled the inclusion criteria of o ur study. We found that the decrease in left ventricular mass index wa s more marked the greater was the decline in blood pressure (systolic r=0.46, P<.001; diastolic r=0.21, P=.08) and the longer was the durati on of therapy (r=0.38, P<.01). After adjustment for different duration s of treatment (mean duration of treatment, 25 weeks), left ventricula r mass decreased 13% with ACE inhibitors, 9% with calcium channel bloc kers, 6% with beta-blockers, and 7% with diuretics. There was a signif icant difference between drug classes (P<.01): ACE inhibitors reduced left ventricular mass more than beta-blockers (significant, P<.05) and diuretics (tendency, P=.08). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness ( P<.05). Conclusions.-The database of articles published through July 1 995 is small and incomplete, and most of the articles are of poor scie ntific quality. in this first meta-analysis including only double-blin d, randomized, controlled clinical studies, decline in blood pressure, duration of drug treatment, and drug class determined the reductions in left ventricular mass index. The ACE inhibitors seemed to be more p otent than beta-blockers and diuretics in the reduction of left ventri cular mass index; calcium channel blockers were somewhat in the interm ediate range. The ACE inhibitors and, to a lesser extent, calcium chan nel blockers emerged as first-line candidates to reduce the risk assoc iated with left ventricular hypertrophy.