Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial

Objective To compare the effects of a calcium antagonist (amlodipine) and a n angiotensin converting enzyme inhibitor (lisinopril) on left Ventricular mass and diastolic function in elderly, previously untreated hypertensives. Design A double-blind randomized parallel group trial. Effects of amlodipin e and lisinopril on left ventricular mass and diastolic function (E/A Ratio ) (The ELVERA trial), Setting Rural northern Netherlands: population screening new diagnosed hype rtensive subjects. Patients The study population comprised 166 newly diagnosed hypertensive (a ged 60-75) with diastolic blood pressure between 95-115 mmHg and/or systoli c blood pressure between 160-220 mmHg, Intervention Patients were randomly allocated to receive 5-10 mg amlodipine or 10-20 mg lisinopril for 2 years. Main outcome measures Prior and after 1 and 2 years of treatment left ventr icular mass, indexed by body surface (LVMI) was estimated by 2-D mode echoc ardiography according to Devereux with use of Penn convention. Early to atr ial filling ratio (E/A) was assessed by transmitral flow. Change from basel ine of LVMI and E/A ratio was evaluated by repeated measurement analysis of the treatment effect in an intention-to-treat analysis. Results Both amlodipine and lisinopril led to equivalent reduction in systo lic and diastolic blood pressure. At the end of the study the amlodipine gr oup led to LVMI decrease by 21,8 g/m less than or equal to [95% confidence interval (CI), 18.3-25.3] and E/A ratio increased by 0.08 (95% CI, 0.05-0,1 1), in the lisinopril group LVMI decreased by 22.4 g/m less than or equal t o (95%, CI, 19.0-25.8) and E/A ratio increased by 0.07 (95% CI, 0,04-0.10). No statistically significant differences were found in changes in LVMI and E/A ratio between amlodipine and lisinopril. Conclusion A long-term study, the ELVERA trial proves that amlodipine and l isinopril reduce left ventricular mass and improve diastolic function to a similar extent in elderly newly diagnosed hypertensive patients. (C) 2001 L ippincott Williams & Wilkins.