Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996).
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Investigation of the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension found that ACE-inhibitors and calcium channel blockers were more potent in reducingleft ventricular mass than beta-blockers, with diuretics in the intermediate range.Abstract:
Objective. To provide an update on the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension. Data sources. Relevant medical databases including MEDLINE, BIOSIS PREVIEWS, EMBASE, and SCISEARCH as well as review articles to December 1996. Study selection. Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design. Data extraction. Literature search and data extraction according to a prefixed scheme performed independently by two investigators. The primary parameter was reduction of left ventricular mass by antihypertensive therapy with placebo, diuretics, β-blockers, calcium channel blockers, or ACE-inhibitors. Data synthesis. Fifty studies published till the end of December 1996 were identified. They comprised a total of 1715 patients in 13 placebo (n=165, age: 50±3 years) and 89 active treatment arms (n=1550, age: 56±10 years) respectively. Overall, for active treatment left ventricular mass index was the more reduced the greater the decrease in systolic blood pressure, (r= 0.27; P<0.05), the longer the duration of therapy (r=0.36; P<0.001), and the higher the pretreatment value of left ventricular mass index (r= 0.53; P<0.001). Left ventricular mass index was decreased by 12% with ACE-inhibitors (95%) CI: 9.0-14.5%), by 11% with calcium channel blockers (95%) CI: 7.8-13.7%), by 5%) with β-blockers (95%) CI: 1.2-7.3%) and by 8% with diuretics (95%) CI: 3.9-11.1%) (overall P<0.01). Subsequent tests revealed that ACE-inhibitors and calcium channel blockers were more effective than β-blockers in reducing left ventricular mass index (P<0.05). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<0.05). Conclusions. Decrease in systolic blood pressure, duration of antihypertensive therapy, degree of pretreatment left ventricular hypertrophy and antihypertensive drug class determined the reduction of left ventricular hypertrophy. ACE-inhibitors and calcium channel blockers were more potent in reducing left ventricular mass than β-blockers, with diuretics in the intermediate range.read more
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Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,Jackson T. Wright,Edward J. Roccella +10 more
TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
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2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension.
TL;DR: There is evidence that specific agents have benefits for patients with particular compelling indications, and that monotherapy is inadequate for the majority of patients, and for patients without a compelling indication for a particular drug class, a low dose of diuretic should be considered for initiation of therapy.
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Lennart Hansson,Thomas Hedner,P. Lund-Johansen,Sverre E. Kjeldsen,Lars H Lindholm,Jan Otto Syvertsen,Jan Lanke,Ulf de Faire,Björn Dahlöf,Bengt E. Karlberg +9 more
TL;DR: Diltiazem was as effective as treatment based on diuretics, beta-blockers, or both in preventing the combined primary endpoint of all stroke, myocardial infarction, and other cardiovascular death.
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Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin.
Adeera Levin,Christopher R. Thompson,Jean Ethier,Euan Carlisle,Sheldon W. Tobe,David C. Mendelssohn,Ellen Burgess,Kailash Jindal,Brendan J. Barrett,Joel Singer,Ognjenka Djurdjev +10 more
TL;DR: There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes in patients with progressive renal disease, and the important modifiable risk factors are defined.
References
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Meta-analyses of randomized controlled trials.
TL;DR: It is concluded that an urgent need exists for improved methods in literature searching, quality evaluation of trials, and synthesizing of the results.
Journal ArticleDOI
Reversal of Left Ventricular Hypertrophy in Essential Hypertension: A Meta-analysis of Randomized Double-blind Studies
TL;DR: In this first meta-analysis including only double-blind, randomized, controlled clinical studies, decline in blood pressure, duration of drug treatment, and drug class determined the reductions in left ventricular mass index.
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Left ventricular hypertrophy as a risk factor.
TL;DR: New and intriguing areas related to ventricular hypertrophy include its regression with certain forms of pharmacologic therapy and not others, which is also being investigated further at this time.
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Reversal of left ventricular hypertrophy.
TL;DR: The authors used each treatment arm of these selected trials as a separate observation and gave up the major advantage of the original design, so a more appropriate analysis would have been not only to calculate the changes within each treatment arms, but also to analyze the differences between the changes.
Journal ArticleDOI
Regression of left ventricular hypertrophy.
TL;DR: The authors indicated that the Treatment of Mild Hypertension Study (TOMHS) 2 was not included in the meta-analysis, among other studies, because it did not fulfill 1 of the 12 inclusion criteria, namely, that the primary goal of the study was to analyze the effects of antihypertensive compounds on left ventricular hypertrophy.