Effect of Imidapril and Nifedipine on??Left Ventricular Hypertrophy in??Untreated Hypertension

Abstract

Imidapril is an ACE inhibitor that is licensed for use in the treatment of hypertension. Studies assessing regression of left ventricular hypertrophy are limited, especially those comparing imidapril with other antihypertensive agents. Single-centre, randomised, double-blind, double-dummy, parallel-group study carried out in a district general hospital. Eighty-six patients with untreated hypertension and left ventricular hypertrophy were included in the study. The mean age of the study population was 54 years and 70% were male. Patients were randomised to treatment with either imidapril or sustained-release nifedipine over a 24-week period. Efficacy was assessed using clinic cuff blood pressure (BP) measurement, ambulatory BP measurement and serial transthoracic echocardiography. In the nifedipine and imidapril groups, respectively, there were significant reductions in clinic BP (16.8mm Hg [20.1, 13.4] vs 11.8mm Hg [15.3, 8.4] drop in mean [95% CI] arterial pressure), ambulatory BP (9.0mm Hg [13.2, 4.9] vs 9.7mm Hg [13.8, 5.7]) and left ventricular mass index (26.4 g/m(2) [36.3, 16.5] vs 20.8 g/m(2)[27.4, 4.1]). No significant differences in effects on these parameters were noted between the nifedipine and imidapril treatment groups (p = ns). There were no significant changes in left ventricular end-diastolic volume, left ventricular end-systolic volume, or stroke volume. Patients on imidapril were more likely to complete the study and experienced fewer adverse effects. Imidapril is a well tolerated ACE inhibitor that has been shown to be as efficacious as sustained-release nifedipine in the treatment of hypertension and left ventricular hypertrophy in patients with previously untreated hypertension.