Abstract 124: The Effectiveness of Angiotensin Converting Enzyme Inhibitors, Angiotensin II Receptor blocker, or Combination in Reducing Left Ventricular Hypertrophy in Hypertensive Patients: A Systematic Review

Abstract

Background: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well established antihypertensive medications. Their role in reducing left ventricular hypertrophy (LVH) over other antihypertensives has also been clearly delineated on previous trials and meta-analysis. However, the difference in LVH reduction between ACEIs, ARBs or their combination is still unknown. Data Sources: The Cochrane Control Trials Register, PUBMED (1970 to April 2012), and hand selected reference list of English-language trials. Study Selection: Fourteen clinical trials comparing ACEI, ARB or both with outcome of interest in hypertensive patients, with duration of at least 6 months and that had minimum 20 patients were found. Data extraction: A predefined data extraction protocol was establish that included study reference, objective, design, population demographics, various interventions, outcomes and study quality. Results: Eleven randomized double blinded trials, 2 randomized open label trials and one case control trials were identified. Nine compared ACEI to ARB only and the remaining 5 compared ACEI, ARB with ACEI and ARB. There is high evidence that the use of ACEI or ARB in hypertensive patient with LVH for duration of at least 6 months, results in significant reduction in left ventricular hypertrophy measured by echocardiography or MRI as left ventricular mass (LVM) and or left ventricular mass index (LVMI). There is no significant difference between the use of ACEI or ARB in LVH reduction. When comparing combination therapy of ACEI and ARB to monotherapy of either ACEI or ARB, there is some evidence of further regression in LVH with combination therapy. The difference was more pronounced in diabetics. Limitations: Studies had small sample sizes with varied duration of therapy in diverse clinical settings, using different ACEIs and ARBs. Conclusion: The current evidence shows that the use of ACEI or ARB in hypertensive patients with LVH results in reduction in LVH. There is no significant difference in LVH reduction between use of ACEI or ARB. The use of both ACEI and ARB provides additional reduction in LVH especially in diabetics; there is however need for larger studies to better delineate these differences.