FACTORS INFLUENCING REDUCTION IN BLOOD-PRESSURE AND LEFT-VENTRICULAR MASS IN HYPERTENSIVE TYPE-1 DIABETIC-PATIENTS USING CAPTOPRIL OR DOXAZOSIN FOR 6 MONTHS

The effect of doxazosin versus captopril on blood pressure, albuminuri a, and left ventricular mass was studied in 33 hypertensive type-1 dia betic patients randomized to 6 months treatment with captopril (17 pat ients, mean daily dose 100 mg) or doxazosin (16 patients, mean daily d ose 9 mg). Casual and 24-h ambulatory blood pressure (24hBP) were redu ced from 163/95 to 144/83 mm Hg and 152/86 to 145/81 mm Hg, respective ly, in the captopril group, and from 160/93 to 145/86 mm Hg and 156/86 to 147/79 mm Hg in the doxazosin group tall P <.05). The achieved 24h BP on treatment was positively associated with pretreatment levels of glycosylated hemoglobin (HbA(1c)) and plasma atrial natriuretic peptid e (r = 0.53 and 0.59, respectively, both P <.01). Albuminuria did not change significantly in either group. Left ventricular hypertrophy was present in 13 patients (7 in the captopril and 6 in the doxazosin gro up). Left ventricular mass was reduced by an average of 27% and 23%, r espectively, in these patients (both P <.01), but did not change signi ficantly in patients without left ventricular hypertrophy. The reducti on in left ventricular mass was positively associated with the presenc e of baseline left ventricular hypertrophy and inversely with dietary sodium intake and achieved casual blood pressure on treatment (R-2 = 0 .59, P <.001). We conclude that doxazosin and captopril used for 6 mon ths are equally effective in reducing blood pressure and left ventricu lar hypertrophy in hypertensive type-1 diabetic patients; the antihype rtensive effect is closely related to glycemic control; and dietary so dium intake and achieved casual blood pressure after treatment are ind ependent determinants of the reduction in left ventricular mass seen i n these patients. Am J Hypertens 1998;11:1178-1187 (C) 1998 American J ournal of Hypertension, Ltd.