EFFECT OF AMLODIPINE ON LEFT-VENTRICULAR MASS IN THE AMLODIPINE CARDIOVASCULAR COMMUNITY TRIAL

As part of the Amlodipine Cardiovascular Community Trial (ACCT), which was a large multicenter study designed to assess the effects of the c alcium channel blocker amlodipine besylate (Norvasc) as monotherapy fo r treatment of mild to moderate hypertension, we sought to determine t he effects of amlodipine on regression of left ventricular (LV) hypert rophy (LVH). The study began with a 2-week placebo run-in period (base line), before which antihypertensive drugs had been discontinued. Amlo dipine was then administered at 5-10 mg/day day during a 4-week titrat ion/efficacy period. Patients achieving a goal diastolic blood pressur e (DBP) of less than or equal to 90 mm Hg or a decrease in DBP of grea ter than or equal to 10 mm Hg entered a 12-week maintenance phase and had the option to continue long-term therapy thereafter. Echocardiogra ms were obtained in a subset of patients at the end of the baseline pe riod. In patients with LVH at baseline, echocardiograms were repeated at the end of 16 weeks of therapy (week 18), and at 42 weeks in patien ts continuing long-term therapy. Thirty-seven percent of 124 hypertens ive patients screened for LVH at baseline had LVH detected on echocard iograms. Blacks had a higher incidence of LVH (64%) as compared with w hites (34%, p < 0.05). Patients with LVH were more likely to have a hi gher baseline systolic BP (SBP) and DBP. Their sitting SBP and DBP dec reased significantly from a mean of 163/102 mm Hg at baseline to 139/8 6 mm Hg with amlodipine therapy at week 18 (p < 0.0001). Amlodipine tr eatment produced a mean decrease of 20-g/m(2) in LV mass index (p < 0. 05) after 16 weeks of treatment and a mean decrease of 43 g/m(2) in LV mass at week 42 (p < 0.001) as compared with baseline. There were no differences in the degree of LV mass regression between men or women o r between older or younger patients; there was a trend toward less reg ression in blacks (-7 +/- 15 g/m(2)) as compared with whites (-22 +/- 9 g/m(2)) at week 18.