781-6 Reversal of Left Ventricular Hypertrophy in Essential Hypertension: Meta-Analysis of Studies with High Scientific Quality

Abstract

Left ventricular hypertrophy (LVH) is a strong, blood pressure independent cardiovascular risk factor. Therefore, reversal of LVH appears to be a desirable goal in treating arterial hypertension. To determine the ability of various antihypertensive agents to reduce left ventricular (LV) mass, we analyzed all published papers with high scientific quality including only double-blind, randomized, controlled clinical studies with parallel group design. After intensive literature search through the end of 1993, data extraction were performed according to a prefixed scheme independently by two investigators. of 432 identified references, only 35 clinical trials fulfilled the criteria of high scientific quality. We found that the decrease in LVH was greater the higher was pretreatment LV mass (r = 0.49, p < 0.01), the greater was the fall in blood pressure (systolic r = 0.43, p < 0.001, diastolic r = 0.26, p < 0.05) and the longer was the duration of therapy (r = 0.36, p < 0.01). After adjustment for different durations of treatment, LV mass fell 16% with ACE inhibitors [95% CI: 13.7–20.6%J, 10% with calcium entry blockers [95% CI: 6.0–14.0%],6% with beta-blockers [95% CI: 2.4–9.6%), and 8% with diuretics [95% CI: 3.6–12.6%). There was a significant difference between drug classes (p < 0.005), and ACE-inhibitors reduced LV mass more than diuretics (p < 0.05) and beta-blockers (p < 0.05). Similar significant differences between drug classes were found with regard to septal (p < 0.02) and posterior wall thickness (p < 0.03). The database published through the end of 1993 is small and incomplete, and the majority of published studies are of poor scientific quality. Pretreatment LV mass, fall in blood pressure, duration of drug treatment, and drug class determined the reductions observed in LV mass. ACE-inhibitors and, to a lesser extent, calcium entry blockers emerged as first-line candidates to reduce the risk associated with LVH.