Regression of Electrocardiographic Signs of Left Ventricular Hypertrophy by Combined Treatment With Thiazide Diuretic and Angiotensin-Ⅱ Receptor Blocker : Randomized Multicenter Trial

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  • Sawa Takuma
    Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
  • Sato Yukihito
    Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
  • Matsuda Mitsuo
    Department of Cardiology, Kishiwada City Hospital
  • Tanaka Masaru
    Division of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital
  • Miyazaki Shunichi
    Division of Cardiology, Department of Medicine, Kinki University
  • Furukawa Yutaka
    Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
  • Kita Yoshio
    Department of Cardiovascular Medicine, Hyogo Prefectural Tsukaguchi Hospital
  • Takatsu Yoshiki
    Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital
  • Fujiwara Hisayoshi
    Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital

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タイトル別名
  • Regression of Electrocardiographic Signs of Left Ventricular Hypertrophy by Combined Treatment With Thiazide Diuretic and Angiotensin-II Receptor Blocker
  • – Randomized Multicenter Trial –

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抄録

Background:In hypertensive patients, left ventricular hypertrophy (LVH) may persist despite satisfactory blood pressure (BP) control. The efficacy of thiazide diuretics in Western countries has been reported, but whether this applies to hypertensive Japanese patients is uncertain.Methods and Results:We randomly assigned 94 patients whose BP was poorly controlled with usual doses of angiotensin-II receptor blockers (ARB), to losartan/hydrochlorothiazide (HCTZ) fixed-dose combination vs. maximum doses of ARB. After 6 months follow-up, decrease in BP, regression of electrocardiographic LVH, and changes in laboratory measurements were examined. Although a similar decrease in BP was observed in both groups, the decrease in LV Sokolow-Lyon voltage, from 34.4±9.2 to 29.4±8.8 mm in the losartan/HCTZ vs. from 29.9±10.2 to 29.1±8.4 mm in the ARB group (P=0.0003), and the decrease in serum B-type natriuretic peptide (BNP) level, from 30.1±28.5 to 26.8±28.0 pg/ml vs. from 23.7±14.8 to 29.8±29.3 pg/ml (P=0.045) were greater in the losartan/HCTZ group. By single variable logistic regression analysis, ∆BNP (P=0.012) and treatment with losartan/HCTZ (P<0.0001) correlated with the regression of LVH. By multiple variable logistic regression analysis, both ∆BNP (P=0.035) and treatment with losartan/HCTZ (P=0.0003) remained significant. No major adverse effects were observed.Conclusions:Greater regression of LVH was safely achieved with losartan/HCTZ in patients whose BP was poorly controlled with an ARB. (Circ J 2014; 78: 2719–2726)

収録刊行物

  • Circulation Journal

    Circulation Journal 78 (11), 2719-2726, 2014

    一般社団法人 日本循環器学会

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