REGRESSION OF LEFT-VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL-HYPERTENSION - RESULTS OF 6-MONTH TREATMENT WITH INDAPAMIDE

Left ventricular hypertrophy (LVH) is a major risk factor for cardiova scular morbidity in hypertensive patients. The effects of diuretics on LVH have raised controversies, but recent studies suggest that diuret ics are able to reduce LVH in hypertensive patients, mainly through a reduction in ventricular diameter. The present multicenter open study was designed to test the effects of indapamide, a widely used nonthiaz ide diuretic, on LVH in patients with essential hypertension. Patients had to have mild-to-moderate essential hypertension (supine diastolic blood pressure [sDBP] 95 to 115 mm Hg) with echocardiographic evidenc e of LVH (left ventricular mass index [LVMI] > 130 g/m(2) for men and > 110 g/m(2) for women). After a 2 week placebo run-in period, eligibl e patients underwent a 6 month treatment with 2.5 mg indapamide daily. All echograms were performed by the same investigator before and afte r 6 months of indapamide. Clinical and biological acceptability and qu ality of life (visual analog scale) were also studied. One hundred and thirty patients were included in the study and 112 completed the tria l. Indapamide induced a significant reduction in systolic and diastoli c blood pressures. Indapamide induced a marked reduction in posterior wall thickness (from 12.1 +/- 2.0 to 11.2 +/- 1.6 mm) and in intervent ricular wall thickness (from 12.7 +/- 1.7 to 11.8 +/- 1.9 mm; each P < .001) and a slight decrease in left ventricular diameter (P = .049). This resulted in a 13% reduction in LVMI (from 161.9 +/- 37.9 to 140.7 +/- 33.8 g/m(2), P < .001). Left ventricular fractional shortening re mained unchanged. There was no significant relation between changes in LVMI and changes in systolic, diastolic, or mean blood pressure. No s ignificant adverse clinical or biological effects were reported during the study. The increased score of the visual analog scale indicated t hat overall well-being was improved (P < .001). Our study indicates th at indapamide, in addition to blood pressure control, is able to reduc e LVH. This effect was achieved mainly through a reduction in wall thi cknesses rather than in internal cavity diameter.