CHANGES IN LEFT-VENTRICULAR MASS DURING TREATMENT WITH MINOXIDIL AND CILAZAPRIL IN HYPERTENSIVE PATIENTS WITH LEFT-VENTRICULAR HYPERTROPHY

Attainment of the regression of hypertension-associated left ventricul ar hypertrophy (LVH) seems to be a desirable goal of blood pressure (B P)-reducing therapy. Since antihypertensive drugs of differing types m ay exhibit markedly different abilities to modulate LVH, we examined t he effects of the angiotensin-converting enzyme inhibitor cilazapril, and the potassium channel activator minoxidil, alone or in combination with each other, on the left ventricular mass (LVM) in patients with severe essential hypertension who had LVH detected by echocardiography . All patients received the same base therapy of bopindolol and guanfa cine. After a run-in period, they were treated with: (1) cilazapril (n = 10); (2) minoxidil, combined with a diuretic (n = 10); or (3) both cilazapril and monoxidil (n = 6) for 12 months. The LVM index (LVMI; L VM per body surface area) was estimated every 3 months by means of ech ocardiography, Each kind of therapy decreased the arterial pressures t o a similar degree. The 1-year treatment with the cilazapril-based reg imen resulted in a significantly diminished LVMI (from a mean +/- s.d. of 173 +/- 38 to 152 +/- 22 g/m(2); P < 0.05). On the other hand, the minoxidil-based therapy led to a significant increase in LVMI (from 1 48 +/- 19 to 170 +/- 35 g/m(2); P < 0.05), There were no significant L VMI changes in patients receiving the combined, cilazapril + minoxidil -based treatment (172 +/- 34 vs the pretreatment 183 +/- 54 g/m(2)). T he results confirm that longterm treatment with cilazapril is effectiv e both in reducing BP and in reducing LVM. In spite of yielding a sati sfactory reduction of BP, minoxidil therapy, even in combination with a diuretic and a beta-blocker, may lead to an aggravation of pre-exist ing LVH; this effect of minoxidil could be prevented by the simultaneo us administration of cilazapril.