To study the effects of the angiotensin II receptor antagonist Losartan and Amlodipine on left ventricular mass (LVM), we performed blood pressure measurements and transthoracic echocardiographies at baseline. After a 4-week placebo run-in period, 25 patients with mild-to-moderate essential hypertension were randomly allocated to active treatment with Losartan 50 mg titrated to Losartan 50 mg/hydrochlorothiazide (HCT) 12.5 mg (n = 11) or Amlodipine 5 mg titrated to 10 mg (n = 14) for 16 weeks. After treatment, blood pressure decreased significantly in both groups. LVM and LVM index (mean ± SD/median) in the Losartan group at baseline were 311 ± 101/288 g and 163 ± 55/150 g/m2 and decreased significantly to 252 ± 25/255 g and 133 ± 22/128 g/m2 (p = 0.003 for LVM; p = 0.01 for LVM index) after 16 weeks of active treatment. In the Amlodipine group LVM and LVM index decreased from 259 ± 47/243 g and 136 ± 25/ 131 g/m2 to 240 ± 42/234 g and 126 ± 24/123 g/m2 (n.s.). In conclusion, LVM decreased significantly as early as 16 weeks after initiation of antihypertensive treatment with the Angiotensin II antagonist Losartan.

Keywords:
Losartan, Amlodipine, Mild-to-moderate hypertension, Left ventricular hypertrophy, Echocardiography
1.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561–1566.
2.
Glen SK, Eliott HL, Curzio JL, Lees KR, Reid JL: White coat hypertension as a cause of cardiovascular dysfunction. Lancet 1996;348:654–657.
3.
Dahlöf B, Pennert K, Hansson L: Reversal of left ventricular hypertrophy in hypertensive patients. A metaanalysis of 109 treatment studies. Am J Hypertens 1992;5:95–110.
4.
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R: Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 1998;97:48–54.
5.
Dahlöf B, Devereux RB, de Faire U, et al. for the LIFE study group: Losartan intervention for end-point reduction in hypertension (the LIFE study). Am J Hypertens 1996;9:26A.
6.
Höglund C, Cifkova R, Mimran A, et al: A comparison of the effects of mibefradil and atenolol on regression of left ventricular hypertrophy in hypertensive patients. Cardiology 1998;89:263–270.
7.
Devereux RB: Do antihypertensive drugs differ in their ability to regress left ventricular hypertrophy? Circulation 1997;95:1983–1985.
8.
Himmelmann A, Svensson A, Bergbrant A, Hansson L: Long-term effects of losartan on blood pressure and left ventricular structure in essential hypertension. J Hum Hypertens 1996;10:729–734.
9.
Cheung B: Letter to Lancet. Increased left-ventricular mass after losartan treatment. Lancet 1997;i:1743–1744.
10.
Cuspidi C, Lonati L, Sampieri L, Valagussa L, Macca G, Leonetti G, Zanchetti A: Effects of losartan on blood pressure and left ventricular mass in essential hypertension. High Blood Pressure 1998;7:75–79.
11.
Thürmann PA, Kenedi P, Schmidt A, Harder S, Rietbrock N: Influence of the Angiotensin II antagonist Valsartan on left ventricular hypertrophy in patients with essential hypertension. Circulation 1998;98:2037–2042.
12.
Lombardo M, Alli C, Broccolino M, Ferrari S, Montemurro L, Zaini G, Zanni D: Long-term effects of angiotensin-converting enzyme inhibitors and calcium antagonists on the right and left ventricles in essential hypertension. Am Heart J 1997;134:557–564.
13.
Leenen FHH, Fourney A: Comparison of the effects of amlodipine and diltiazem on 24-hour blood pressure, plasma catecholamines, and left ventricular mass. Am J Cardiol 1996;78:203–207.
14.
Agabiti-Rosei E, Muiesan ML, Rizzoni D, Zulli R, Calebich S, Castellano M, Cavaliere G, Nordio G, Pasini F, Zuccato F: Cardiovascular structural changes and calcium antagonist therapy in patients with hypertension. J Cardiovasc Pharmacol 1994;24:S37–S43.
15.
Dahlöf B, Lindholm LH, Carney S, Pentikäinen PJ, Oestergren J: Main results of the losartan versus amlodipine (LOA) study on drug tolerability and psychological general well-being. J Hypertens 1997;15:1327–1335.
16.
Nyman L, Taure K, Cullberg M, Lagwerström PO: Encapsulation of commercially available losartan for blinding purposes does not affect its bioavailability. Clin Drug Invest 1998;15(4):361–365.
17.
Wallerson DC, Devereux RB: Reproducibility of echocardiographic left ventricular measurements. Hypertension 1987;9(suppl 2):6–18.
18.
Cuspidi C, Boselli L; Bragato R, Lonati L, Sampieri L, Bocciolone M, Leonetti G, Zanchetti A: Echocardiographic and ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension. Cardiology 1992;80:305–311.
19.
Cottone S, Vadalà A, Vella MC, Vardi E, Mulé G, Contorno A, Riccobene R, Cerasola G: Changes of plasma endothelin and growth factor levels, and of left ventricular mass, after chronic AT1-receptor blockade in human hypertension. Am J Hypertens 1998;11(5):548–553.
20.
Tedesco MA, et al: Effects of losartan on hypertension and left ventricular mass: A long-term study. J Hum Hypertens 1998;12:505–510.
21.
Kahan T, Malmquist K, Edner M, Held M, Osbakken M: Rate and extent of left ventricular hypertrophy regression: A comparison of angiotensin II blockade with irbesartan and beta-blockade (abstract). JACC 1998;31;2 (suppl):857.
22.
Zabalgoitia M: Left ventricular mass and function in primary hypertension. Am J Hypertens 1996;9:55S–59S.
23.
Tikkanen I, Omvik P, Jensen HE: Comparison of the angiotensin II antagonist losartan with the angiotensin converting enzyme inhibitor enalapril in patients with essential hypertension. J Hypertens 1995;13:1343–1351.
24.
Franz IW, Tönnesmann U, Müller JFM: Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with angiotensin converting enzyme inhibitors. Am J Hypertens 1998;11:631–639.
25.
Devereux RB, Dahlöf B: Criteria for an informative trial on left ventricular hypertrophy regression. J Hum Hypertens 1994;8:735–739.
© 2000 S. Karger AG, Basel
2000
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