Effects of spironolactone-altizide on left ventricular hypertrophy

Objective - To investigate the effects of the association spironolactone (2 5 mg) / altizide (15 mg) as monotherapy on left ventricular hypertrophy (LV H) in patients with mild to moderate hypertension. Additionally, to study t he correlation between left ventricular mass (LVM) index and electrocardiog raphic (ECG) criteria for LVH. Methods and results - This was an open, prospective study of 6 months. Pati ents with mild to moderate essential hypertension were treated with spirono lactone/altizide for two months and were included in the study if their blo od pressure (BP) at the end of this first treatment period was normalised a ccording to protocol criteria (systolic BP < 160 mm Hg and diastolic BP < 9 5 mm Hg). Patients then entered a second 4-month treatment period. LVM was determined by echocardiography performed at the beginning of treatm ent and after 6 months. LVH was defined as LVM greater than or equal to 100 g/m(2) in women and LVM greater than or equal to 131 g/m(2) in men. Echoca rdiograms were interpreted blindly by two echocardiography reading laborato ries. Seventy-one patients with a normalised BP after two months of treatment, we re enrolled in the study. Changes in LVM index were studied in 31/71 patien ts with LVH (25 women and 6 men, mean LVM index +/- (SD) 119.9 +/- 16.4 g/m (2) in women and 147.8 +/- 10.9 g/m(2) in men). Spironolactone/altizide sig nificantly reduced LVM index by 10 %, from 125.3 +/- 22.5 to 114.2 +/- 25.1 g/m(2) (p < 0.005). Posterior and septal wall thickness decreased by 4 % ( p = 0.06) and 5 % (p = 0.026), respectively. End-diastolic dimension was re duced by 3 %, from 50.3 +/- 3.3 to 48.9 +/- 3.4 mm (p = 0.006). The posteri or wall thickness to end-diastolic dimension ratio remained unchanged. Comp lete regression of LVH according to mass criteria occurred in 11 patients o ut of 31 (34.5 %). The observed changes in ECG voltage criteria were in acc ordance with a decrease of LVM index. Conclusion - In this open study, the potassium-sparing diuretic spironolact one/altizide decreases LVM index in hypertensive patients, who were selecte d for follow-up because they had echocardiographic LVH and because their BP had normalised during an initial 2-month treatment period.