Ace inhibitor ramipril is more effective than the β-blocker atenolol in reducing left ventricular mass in hypertension. Results of the RACE (Ramipril cardioprotective evaluation) study

Enrico Agabiti-Rosei, Ettore Ambrosioni, Cesare Dal Palù, M. Lorenza Muiesan, Alberto Zanchetti, A. Zanchetti, C. Cuspidi, A. Libretti, R. Sega, C. Mazzola, C. Piemonti, C. Pasotti, A. Capra, E. Uslenghi, G. Ugliengo, C. Dal Palu, A. Semplicini, P. Maiolino, A. Rossi, P. PascottoD. D’Este, C. Martines, D. Marchese, D. Zanuttini, D. Pavan, P. Zonzin, R. Fiorencis, R. Miori, G. De Venuto, D. Brachetti, U. De Castro, A. Brunelli, A. Alboni, F. Ippolito, G. Tumiotto, S. Bosi, C. Guadagni, R. Agosta

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Objectives: To compare the effect of the angiotensin converting enzyme (ACE) inhibitor ramipril with that of the β-blocker atenolol on reversal of left ventricularhypertrophy, on blood pressure and on other echocardiographic parameters. Design: The study was conducted in accord with the PROBE(prospective randomizedopen blinded endpoint) design. Randomized treatment either with ramipril or withatenolol was continued for 6 months, and echocardiograms were recorded beforeand after 3 and 6 months of treatment. The echo tracings were blindly evaluated ina single reading centre. Methods: M-mode, two-dimensional guided echocardiography was used to measureleft ventricular wall thicknesses and dimensions, from which left ventricular masswascalculated, according to the Penn convention. Results: Of 193 patients at 16 centres, 111 had echocardiograms that could bequantitatively evaluated. The primary analysis of the study was performed using datafrom those patients. In addition, echocardiograms of 88 patients were analysed onan ’according to protocol’ basis (patients with preset values of left ventricular mass). Systolic and diastolic blood pressures were significantly reduced both by ramipriland by atenolol without any significant difference between the two drug treatments. The heart rate was significantly reduced by atenolol only. Both the ’primary’ and the’according to protocol’ analysesshowed that the left ventricular masswas significantlyreduced by ramipril only. Comparison between treatments according to a multivariateanalysis demonstrated a significantly greater reduction in left ventricular massduringramipril than during atenolol treatment. Conclusions: The present study is the first of suitably large size in which a directcomparison of the effects of an ACE inhibitor and a β-blocker on echocardiographicleft ventricular mass has been performed. It has demonstrated that ramipril ismore effective than atenolol in reversing left ventricular hypertrophy in essentialhypertensive patients.

Original languageEnglish
Pages (from-to)1325-1334
Number of pages10
JournalJournal of Hypertension
Issue number11
Publication statusPublished - 1995


  • Angiotensin converting enzyme inhibitors
  • Left ventricular hypertrophy regression
  • β-blockers

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Endocrinology


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