Abstract
BackgroundMost antihypertensive drugs used in monotherapy or in combination therapy reduce the left ventricular mass index (LVMI). However, little is known about the effects on LVMI of a triple fixed-dose combination (TFC) therapy, containing in a single pill an angiotensin-converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB). MethodsIn this prospective open-label study, 92 patients with essential hypertension were randomized to treatment with a TFC of perindopril/indapamide/amlodipine at different doses or a triple free combination therapy (FCT) including ACEI/diuretic/CCB. Office blood pressure (BP) measurement, 24 h-ambulatory BP monitoring and echocardiography were performed at baseline and during a 14-month follow-up. The BP variability (BPV) over 24 h was calculated as ± standard deviation of the daytime systolic BP. Differences between office and monitored BP and LVMI were evaluated by ANOVA for repeated measures. ResultsA significant BP-lowering effect was observed for both treatments. At follow-up, BPV was reduced in both the treatment groups vs. the baseline (14.0±1.5 vs. 17.0±1.8 and 16.2±2.1 vs. 17.6±2.3, respectively), but it was lower in the TFC vs. the FCT group (14.0±1.5 vs. 16.1±2.2, P < 0.05). LVMI was lower in both the treatment groups, but the change was greater for TFC vs. FCT (−8.3±4.9% vs. −2.0 ±2.1%, P < 0.0001). Left ventricular hypertrophy (LVH) regression was greater in the TFC vs. the FCT group (43.5% vs. 30.4%, P < 0.05). ConclusionsIndependently of BP values achieved, the antihypertensive TFC therapy was more effective than FCT in LVMI reduction and LVH regression, possibly related to drugs’ intrinsic properties and to BPV modulation.
Highlights
Left ventricular hypertrophy (LVH) is a compensatory process representing an initial adaptation to increased ventricular wall stress [1]
Little is known about the effects on left ventricular mass index (LVMI) changes and left ventricular hypertrophy (LVH) regression of a triple fixed-dose combination (TFC) therapy containing in a single pill an angiotensin converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB)
The aim of this study was to evaluate the efficacy of the TFC therapy vs. free combination therapy (FCT) in LVMI reduction and in LVH regression, with a target blood pressure (BP) defined as SBP < 140 mmHg plus DBP < 90 mmHg in office, and as SBP < 130 mmHg plus DBP < 80 mmHg at 24 h-ambulatory blood pressure monitoring (ABPM)
Summary
Left ventricular hypertrophy (LVH) is a compensatory process representing an initial adaptation to increased ventricular wall stress [1]. The prevalence of LVH is quite low in the general population increasing to 7–40% in hypertensive population [2]. An echocardiographic screening revealed that the prevalence of LVH could reach over 50% of subjects older than 65 years [3]. The relationship between echocardiographic left ventricular mass index (LVMI) and clinic blood pressure (BP) is usually weak, while the 24 h ambulatory blood pressure monitoring (ABPM) has shown a much closer correlation between LVMI and average daytime BP values [4]. Most antihypertensive drugs used in monotherapy or in combination therapy reduce the left ventricular mass index (LVMI). Little is known about the effects on LVMI of a triple fixed-dose combination (TFC) therapy, containing in a single pill an angiotensin converting enzyme inhibitor (ACEI), a diuretic and a calcium channel blocker (CCB)
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