MADRID — Antihypertensive therapy with candesartan was shown to reverse left ventricular hypertrophy in a study, Dr. Vivencio Barrios reported at the annual meeting of the European Society of Hypertension.
Findings in several recently published controlled randomized trials have shown that regression of electrocardiographic left ventricular hypertrophy (LVH) improves prognosis of hypertensive patients, “but information on LVH regression in clinical practice has been scarce,” said Dr. Barrios of the cardiology institute at Ramon y Cajal Hospital, Madrid.
Dr. Barrios was the lead investigator in an open-label, 12-month study evaluating the impact of candesartan, an angiotensin-1 receptor blocker, on LVH in a real-world practice setting. The study involved 276 patients with uncontrolled essential hypertension. The mean blood pressure at baseline was 164/92 mm Hg. The patients' average age was 62 years, and 18% had diabetes.
The researchers assessed LVH with electrocardiography by using the Cornell voltage duration product (VDP) measurement, as well as QRS-segment duration. The baseline and posttreatment ECG tracings were assessed by a single lab, by a blinded investigator. At the outset of the study, 24% of the patients had LVH.
Patients were treated with candesartan 8 mg/day or 16 mg/day, with the objective of reaching pressures below 140/90 mm Hg for nondiabetics or 130/80 for diabetic patients. The researchers could add other antihypertensive medications if the pressure values did not drop within target ranges after several months.
At 12 months, the angiotensin-1 receptor blocker produced the expected degree of pressure reduction, decreasing the baseline mean values of 164/92 mm Hg to 143/84 mm Hg. It also produced a significant decrease in the prevalence of LVH. By the end of the study, 20% of the study population had ECG evidence of LVH, down from 24% at the outset. Of those with LVH, 19% showed observable LVH regressions.
On average, the VDP was significantly reduced by 132.88 mm × msec; the QRS interval was also reduced by 2.95 msec, both indicating a trend away from LVH.
The VDP changes were larger in older patients and in those with higher baseline VDP values, suggesting candesartan offers the greatest potential benefit in those with the most advanced LVH.
Earlier detection and reversal of LVH is of great concern among hypertension specialists who hope that primary care physicians will join them in their efforts to prevent heart failure, for which advanced age and presence of LVH are the top risk factors.