Effects of valsartan or ramipril addition to amlodipine/hydrochlorothiazide combination on left ventricular mass in diabetic hypertensive patients with left ventricular hypertrophy

Roberto Fogari, Annalisa Zoppi, Amedeo Mugellini, Pamela Maffioli, Paola Preti, Giuseppe Derosa

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this study was to compare valsartan or ramipril addition to amlodipine hydrochlorothiazide (HCTZ) on blood pressure (BP) and left ventricular hypertrophy (LVH) in hypertensive diabetic patients with LVH. Research design and methods: 293 patients were treated with amlodipine 10 mg HCTZ 12.5 combination and then randomized to receive valsartan 160 mg or ramipril 5 mg, in addition to the previous therapy, for 1 year. Main outcome measures: Clinic BP was measured every month; echocardiographic assessments were performed at the end of the placebo period, both before the randomization and after 1-year of triple combination therapy. Results: Both triple regimens similarly reduced SBP/DBP values (-13.5/10.9 mm Hg in the valsartan group and -13.4/10.4 mm Hg in the ramipril group). Triple combination including valsartan better reduced LVMI (-20.1%, p <0.001), interventricular septal thickness (IVST) (-20.3%, p <0.001) and left ventricular posterior wall thickness (PWT) (-16.3%, p <0.001), compared with triple combination including ramipril (-14%, p <0.01; -16.2%, p <0.001 and -9%, p <0.01, respectively); the difference between treatments being statistically significant (p <0.05). Triple combination with valsartan gave a greater increase of E/A ratio (p <0.05 between groups). Conclusions: Valsartan addition to dual therapy with amlodipine HCTZ was more effective than ramipril addition in reducing LVH.

Original languageEnglish
Pages (from-to)1091-1099
Number of pages9
JournalExpert Opinion on Pharmacotherapy
Volume13
Issue number8
DOIs
Publication statusPublished - Jun 2012

Keywords

  • Amlodipine
  • Ramipril
  • Triple therapy
  • Type 2 diabetes mellitus
  • Valsartan
  • Ventricular hypertrophy

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

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