Effects of once-daily angiotensin-converting enzyme inhibition and calciumchannel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension - The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) trial

Background-The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) study was designed to test whether e nalapril achieves greater left ventricular (LV) mass reduction than does a nifedipine gastrointestinal treatment system by a prognostically meaningful degree on a population basis (10 g/m(2)). Methods and Results-An ethnically diverse population of 303 men and women w ith essential hypertension and increased LV mass at screening echocardiogra phy were enrolled at clinical centers on 4 continents and studied by echoca rdiography at baseline and after 6- and 12-month randomized therapy. Clinic al examination and blinded echocardiogram readings 48 weeks after study ent ry in an intention-to-treat analysis of 113 enalapril-treated and 122 nifed ipine-treated patients revealed similar reductions in systolic/diastolic pr essure (-22/12 versus -21/13 nun Hg) and LV mass index (-15 versus -17g/m(2 ), both P>0.20). No significant between-treatment difference was detected i n population subsets defined by monotherapy treatment, sex, age, race, or s everity of baseline hypertrophy. Similarly, there was no between-treatment difference in change in velocities of early diastolic or atrial phase trans mitral blood flow. More enalapril-treated than nifedipine-treated patients required supplemental treatment with hydrochlorothiazide (59% versus 34%, P <0.001) but not atenolol (27% versus 22%, NS). Conclusions-Once-daily antihypertensive treatment with enalapril or long-ac ting nifedipine, plus adjunctive hydrochlorothiazide and atenolol when need ed to control blood pressure, both had moderately beneficial and statistica lly indistinguishable effects on regression of LV hypertrophy.