0
May 15, 1996, Vol 275, No. 19 >
ARTICLE | May 15, 1996

Reversal of Left Ventricular Hypertrophy in Essential Hypertension: Title and subTitle BreakA Meta-analysis of Randomized Double-blind Studies FREE

Roland E. Schmieder, MD; Peter Martus, PhD; Arnfried Klingbeil, MD
[+] Author Affiliations

Reprints: Roland E. Schmieder, MD, Medizinische Klinik IV, Universität Erlangen-Nürnberg, Breslauer Str 201, 90471 Nuremberg, Germany.


JAMA. 1996;275(19):1507-1513. doi:10.1001/jama.1996.03530430051039
Text Size: A A A
Published online
Article
References

Objective.  —To determine the ability of various antihypertensive agents to reduce left ventricular hypertrophy, a strong, blood pressure—independent cardiovascular risk factor, in persons with essential hypertension.

Data Sources.  —MEDLINE, DIMDI, RINGDOC, ADES, EMBASE, and review articles through July 1995 (English-language and full articles only).

Study Selection.  —Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design.

Data Extraction.  —Intensive literature search and data extraction according to a prefixed scheme performed independently by 2 investigators. Reduction of left ventricular mass index after antihypertensive therapy with placebos, diuretics, β-blockers, calcium channel blockers, or angiotensin-converting enzyme (ACE) inhibitors was the principal parameter.

Data Synthesis.  —Of 471 identified references describing the effects of antihypertensive drugs on left ventricular hypertrophy, only 39 clinical trials fulfilled the inclusion criteria of our study. We found that the decrease in left ventricular mass index was more marked the greater was the decline in blood pressure (systolic r=0.46, P<.001; diastolic r=0.21, P=.08) and the longer was the duration of therapy (r=0.38, P<.01). After adjustment for different durations of treatment (mean duration of treatment, 25 weeks), left ventricular mass decreased 13% with ACE inhibitors, 9% with calcium channel blockers, 6% with β-blockers, and 7% with diuretics. There was a significant difference between drug classes (P<.01): ACE inhibitors reduced left ventricular mass more than β-blockers (significant, P<.05) and diuretics (tendency, P=.08). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<.05).

Conclusions.  —The database of articles published through July 1995 is small and incomplete, and most of the articles are of poor scientific quality. 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. The ACE inhibitors seemed to be more potent than β-blockers and diuretics in the reduction of left ventricular mass index; calcium channel blockers were somewhat in the intermediate range. The ACE inhibitors and, to a lesser extent, calcium channel blockers emerged as first-line candidates to reduce the risk associated with left ventricular hypertrophy.(JAMA. 1996;275:1507-1513)

REFERENCES

1 +
Messerli FH.  Going to the heart of the matter. Circulation . 1990;;81:1128-1135.
2 +
Mensah GA, Pappas TW, Koren MJ, Ulin RJ, Laragh JH, Devereux RB.  Comparison of classification to hypertension severity by blood pressure level and World Health Organization criteria for prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension. J Hypertens . 1993;;11:1429-1440.
3 +
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.
4 +
Levy D, Anderson KM, Savage DD, Kannel WB, Christiansen JC, Castelli WP.  Echo-cardiographically detected left ventricular hypertrophy: prevalence and risk factors: the Framingham Heart Study. Ann Intern Med . 1988;;108:7-13.
5 +
Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH.  Relation to left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med . 1991;;114:345-352.
6 +
Silberberg JS, Barre PE, Prichard SS, Snidermann AD.  Impact of left ventricular hypertrophy as survival of end-stage renal disease. Kidney Int . 1989;;36:286-290.
7 +
Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS.  The prognostic role of left ventricular artery disease. Ann Intern Med . 1992;;117:831-835.
8 +
Strauer BE.  Ventricular functions and coronary hemodynamics in hypertensive heart disease. Am J Cardiol . 1979;;44:999-1006.
9 +
Messerli FH, Ventura HO, Elizardi DJ, Dunn FG, Frohlich ED.  Hypertension and sudden death: increased ventricular ectopy activity in left ventricular hypertrophy. Am J Med . 1984;;77:18-22.
10 +
de Simone G, Devereux RB, Roman MJ, et al.  Assessment of left ventricular function by the mid-wall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol . 1994;;23:1444-1451.
11 +
Tubau JF, Szlachcic J, Braun S, Massie BM.  Impaired left ventricular functional reserve in hypertensive patients with left ventricular hypertrophy. Hypertension . 1989;;14:1-8.
12 +
Smith VE, Schulman P, Karimeddini MK, White WB, Meeran MK, Katz AM.  Rapid ventricular filling in left ventricular hypertrophy, II: pathologic hypertrophy. J Am Coll Cardiol . 1985;;5:862-868.
13 +
Koren MJ, Ulin R, Laragh JH, Devereux RB.  Reduction of left ventricular mass during treatment of essential hypertension is associated with improved prognosis. Am J Hypertens . 1991;;4:1A.
14 +
Yurenev AP, Dyakonova HG, Novkov ID, et al.  Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Am J Hypertens . 1992;;5:5182-5189.
15 +
Messerli FH, Nunez BD, Ventura HO, Snyder DW.  Overweight and sudden death: increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med . 1987;;147:1725-1728.
16 +
Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD.  Dietary salt intake: a determinant of cardiac involvement in essential hypertension. Circulation . 1988;;78:951-956.
17 +
Liebson P, Prineas R, Grandits G, Dianzumba S, Grimm R, for TOMHS Research Group.  Variables associated with regression of left ventricular mass (LVM) in the Treatment of Mild Hypertension Study (TOMHS). Circulation . 1992;;85( (suppl 1) ):599.
18 +
Jul AM, Karanko HM.  Effects of left ventricular hypertrophy of long-term nonpharmacological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation . 1994;;89:1023-1031.
19 +
Alpert MA, Terry BE, Kelly DL.  Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol . 1985;;55:783-786.
20 +
MacMahon SW, Wilcken DEL, Macdonald GJ.  The effect of weight reduction on left ventricular mass: a randomized controlled trial in young, overweight hypertensive patients. N Engl J Med . 1986;; 314:334-339.
21 +
Jennings G, Dart A, Meredith I, Korner P, Laufer E, Dewar E.  Effects of exercise and other nonpharmacological measures on blood pressure and cardiac hypertrophy. J Cardiovasc Pharmacol . 1991;;17( (suppl 2) ):570-574.
22 +
Kelemen MH, Effron MB, Valenti SA, Stewart KJ.  Exercise training combined with antihypertensive drug therapy. JAMA . 1990;;263:2766-2771.
23 +
Devereux RB.  Angiotensin converting enzyme inhibition and regression of hypertensive left ventricular hypertrophy.  In: MacGregor GA, Severs PS, eds. Current Advances in ACE Inhibition 2 . Edinburgh, Scotland: Churchill Livingstone; 1991;:43-52.
24 +
Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC.  Meta-analyses of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
25 +
Devereux RB.  Detection of left ventricular hypertrophy by M-mode echocardiography: anatomic validation, standardization, and comparison to other methods. Hypertension . 1987;;9( (suppl II) ):II-19—II-26.
26 +
Schmieder R, Messerli FH, Sturgill D, Garavaglia GE, Nunez BD.  Cardiac performance after reduction of myocardial hypertrophy. Am J Med . 1989;;87:22-27.
27 +
1993 Joint National Committee.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V). Arch Intern Med . 1993;;153:154-183.
28 +
Kaplan NM, Liebermann E.  Treatment of hypertension: drug therapy.  In: Kaplan NM, ed. Clinical Hypertension . 5th ed. Baltimore, Md: Williams & Wilkins; 1990;:182-267.
29 +
Dickersin K, Hewitt P, Mutch L, Chalmers I, Chalmers TC.  Revising the literature: comparison of MEDLINE searching with a perinatal clinical trials database. Control Clin Trials . 1985;;6:306-317.
30 +
Christensen R. Plane Answers to Complex Questions: The Theory of Linear Models . New York, NY: Springer Publishing Co; 1987;:22-25, 53-55.
31 +
Norusis MJ. SPSS for Windows: Advanced Statistics Release 6.0 . Chicago, Ill: SPSS Inc; 1993;.
32 +
Agabiti-Rosei E, Ambrosioni E, Finardi G, et al.  Perindopril versus captopril: efficacy and acceptability in an Italian multi center trial. Am J Med . 1992;;92( (suppl 4B) ):795-783.
33 +
Carr AA, Prisant LM.  The new calcium antagonist isradipine: effect on blood pressure and the left ventricle in black hypertensive patients. Am J Hypertens . 1990;;3:8-15.
34 +
Chan TYK, Woo KS, Nicholls MG.  The application of nebivolol in essential hypertension. Int J Cardiol . 1992;;35:387-395.
35 +
Dahlöf B, Hansson L.  Regression of left ventricular hypertrophy in previously untreated essential hypertension: different effects of enalapril and hydrochlorothiazide. J Hypertens . 1992;;10:1513-1524.
36 +
de Simone G, Ferrara LA, Di Lorenzo L, Lauria R, Fasano ML.  Effects of slow-release nifedipine on left ventricular mass and systolic function in mild or moderate hypertension. Curr Ther Res . 1984;;36:537-544.
37 +
de Simone G, Costantino G, Soro S, et al.  Effects of nicardipine on left ventricular hemodynamic patterns in systemic hypertension. Am J Hypertens . 1989;;2:139-145.
38 +
Dittrich HC, Adler J, Ong J, Reitman M, Weber M, Ziegler M.  Effects of sustained-release nicardipine on regression of left ventricular hypertrophy in systemic hypertension. Am J Cardiol . 1992;; 69:1559-1564.
39 +
Fernandez PG, Kim BK, Snedden W, Nolan R, Ko P.  Left ventricular changes after chronic therapy with enalapril maleate in moderate to severe hypertensive patients. Curr Med Res Opin . 1984;;9:170-183.
40 +
Ferrara LA, Fasano ML, de Simone G, Soro S, Gagliardi R.  Antihypertensive and cardiovascular effects of nitrendipine. Clin Pharmacol Ther . 1985;; 38:434-438.
41 +
Ferrara LA, de Simone G, Mancini M, Fasano ML, Pasanisi F, Vallone G.  Changes in left ventricular mass during a double-blind study with chlorthalidone and slow-release nifedipine. Eur J Clin Pharmacol . 1984;;27:525-528.
42 +
Frishman WH, Glasser SP, Strom JA, Schoenberger JA, Liebson P, Poland MP.  Effects of dilevalol, metroprolol and atenolol on left ventricular mass and function in nonelderly and elderly hypertensive patients. Am J Cardiol . 1989;;63:691-741.
43 +
Genovesi-Ebert A, Marabotti C, Palombo C, et al.  Effect of a new multifactorial antihypertensive on heart morphology and function in mild to moderate essential arterial hypertension. Eur Heart J . 1992;;13( (suppl A) ):45-48.
44 +
Giles TD, Sander GE, Roffidal LC, Thomas MG, Given MB, Quiroz AC.  Comparison of nitrendipine and hydrochlorothiazide for systemic hypertension. Am J Cardiol . 1987;;60:103-106.
45 +
Glasser SP, Koehn DK, Powell R.  Regression of left ventricular hypertrophy in treated hypertensive patients with dilevalol and metoprolol. J Clin Pharmacol . 1989;;29:791-797.
46 +
González-Fernández RA, Rivera M, Rodriguez PJ, et al.  Prevalence of ectopic ventricular activity after left ventricular mass regression. Am J Hypertens . 1993;;6:308-313.
47 +
González-Fernández RA, Altieri PI, Fernández-Martinez J, Lugo JE.  Prevalence of ventricular arrhythmias after left ventricular mass regression in the elderly. Cardiol Elderly . 1993;;1:185-190.
48 +
Gosse P, Roudaut R, Dallocchio M.  Effets du vérapamil et de la nifédipine sur la pression artérielle au repos et à léffort et la masse ventriculaire gauche. Arch Mal Coeur . 1992;;85:1249-1252.
49 +
Graettinger WF, Lipson JL, Klein RC, Cheung DC, Weber MA.  Comparison of antihypertensive therapies by noninvasive techniques. Chest . 1989;;96: 74-79.
50 +
Grandi AM, Venco A, Barzizza F, et al.  Double-blind comparison of perindopril and captopril in hypertension. Am J Hypertens . 1991;;4:516-520.
51 +
Leehey DJ, Hartman E.  Comparison of diltiazem and hydrochlorothiazide for treatment of patients 60 years of age or older with systemic hypertension. Am J Cardiol . 1988;;62:1218-1223.
52 +
Leonetti G, Fogari R, Mazzola C, Mangiameli S, Castello C.  Comparison of the effects on blood pressure and left ventricular hypertrophy of lacidipine and hydrochlorothiazide in hypertensive patients. J Hypertens . 1991;;9( (suppl 3) ):529-531.
53 +
Licata G, Scaglione R, Capuana G, et al.  Mediumterm doubleblind study of indenolol in hypertensive patients. Curr Ther Res . 1989;;46:103-110.
54 +
López NC, Corral JL, Rincón LA, et al.  Nitrendipine and atenolol in essential hypertension in young and middle-aged patients. J Cardiovasc Pharmacol . 1991;;18( (suppl 1) ):S101-S105.
55 +
Otterstad JE, Froeland G, Wasenuis Soeyland AK, Knutsen KM, Ekeli T.  Changes in left ventricular dimensions and systolic function in 100 mildly hypertensive men during one year's treatment with atenolol vs. hydrochlorothiazide and amiloride (Moduretic). J Intern Med . 1992;;231:493-501.
56 +
Schneeweiss A, Rosenthal J, Marmor A.  Comparative evaluation of the acute and chronic effects of cilazapril and hydrochlorothiazide on diastolic cardiac function in hypertensive patients. J Hum Hypertens . 1990;;4:535-539.
57 +
Schulman SP, Weiss JL, Becker LC, et al.  The effects of antihypertensive therapy on left ventricular mass in elderly patients. N Engl J Med . 1990;;322:1350-1356.
58 +
Schulte KL, Meyer-Sabellek W, Liederwald K, van Gemmeren D, Lenz T, Gotzen R.  Relation of regression of left ventricular hypertrophy to changes in ambulatory blood pressure after long-term therapy with perindopril versus nifedipine. Am J Cardiol . 1992;;70:468-473.
59 +
Senior R, Imbs JI, Bory M, et al.  Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study. J Cardiovasc Pharmacol . 1993;;22( (suppl 6) ):S106-S110.
60 +
Shigematsu S, Haramatsu K, Aizawa T, et al.  Regression of left ventricular hypertrophy in patients with essential hypertension. Cardiology . 1990;; 77:280-286.
61 +
Szlachcic J, Tubau JF, Vollmer C, Massie BM.  Effect of diltiazem on left ventricular mass and diastolic filling in mild to moderate hypertension. Am J Cardiol . 1989;;63:198-201.
62 +
Szlachcic J, Hall WD, Tubau JF, et al.  Left ventricular hypertrophy reversal with labetalol and propranolol. Cardiovasc Drug Ther . 1990;;4:427-434.
63 +
van Leeuwen JTM, ten Berge BS, Hamer JPM, et al.  Comparative study of lisinopril and metoprolol in mild to moderate hypertension: antihypertensive efficacy using office, ambulatory and exercise blood pressure and effect of treatment on left ventricular mass and exercise tolerance. J Drug Dev . 1992;;5:119-127.
64 +
Weiss RJ, Bent B.  Diltiazem-induced left ventricular mass regression in hypertensive patients. J Clin Hypertens . 1987;;3:135-143.
65 +
Wetzchewald D, Klaus D, Garanin G, Lohr E, Hoffmann J.  Regression of left ventricular hypertrophy during long-term antihypertensive treatment—a comparison between felodipine and the combination of felodipine and metroprolol. J Intern Med . 1992;;231:303-308.
66 +
Steensgaard-Hansen F, Carlsen JE.  Effects of long term treatment with pinacidil and nifedipine on left ventricular anatomy and function in patients with mild to moderate systemic hypertension. Drugs . 1988;;36( (suppl 7) ):70-76.
67 +
Leonetti G, Fogari R, Mazzola C, et al.  Effects of blood pressure reduction with trandolapril and enalapril on left ventricular hypertrophy and exercise tolerance. J Hypertens . 1993;;11:5356-5357.
68 +
Lièvre M, Guéret P, Gayet C, et al, on behalf of the HYCAR Study Group.  Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. Hypertension . 1995;;25:92-97.
69 +
Vyssoulis GP, Valiouli MA, Karpanou EA, Toutouzas PK.  Left ventricular and aortic root structure and function changes with beta blocker antihypertensive therapy: a one-year double blind study of celiprolol and metoprolol. Int J Cardiol . 1995;;49:45-54.
70 +
Neaton JD, Grimm RH Jr, Prineas RJ, et al, for the Treatment of Mild Hypertension Study Group.  Treatment of Mild Hypertension Study: final results. JAMA . 1993;;270:718-724.
71 +
Dahlöf B, Pennert K, Hansson L.  Reversal of left ventricular hypertrophy in hypertensive patients: a meta-analysis of 109 treatment studies. Am J Hypertens . 1992;;5:95-110.
72 +
Cruickshank J, Lewis J, Moore V, Dodd C.  Reversibility of left ventricular hypertrophy of different types of antihypertensive therapy. J Hum Hypertens . 1992;;6:85-90.
73 +
Eagle KA, Blank DJ, Agniar E, Firth LM.  Economic impact of regression of left ventricular hypertrophy by antihypertensive drugs. J Hum Hypertens . 1993;;7:341-351.
74 +
Böhlen L, Weidman P, de Courten M, Erne P, Shaw S.  Antihypertensive drug effects on left ventricular hypertrophy. J Hypertens . 1994;;12( (suppl 3) ): S140.
75 +
Agabiti-Rosei E, Ambrosioni E, dal Palù C, Muiesan ML, Zanchetti A, on behalf of the RACE Study Group.  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. J Hypertens . 1995;;13:1325-1334.
76 +
Grodzicki T, Messerli FH, Savia F, Aristizabal D.  Determinants of left ventricular mass reduction in essential hypertension. Circulation . 1992;;86( (suppl 1) ): 64.
77 +
Schunkert H, Hense HW, Holmer SR, et al.  Association between a deletion polymorphism of the angiotensin-converting-enzyme gene and left ventricular hypertrophy. N Engl J Med . 1994;;330: 1634-1638.
78 +
Schmieder R, Messerli FH, Garavaglia GE, Nunez BD, MacPhee AA, Re NR.  Does the renin-angiotensin-aldosterone system modify cardiac structure and function in essential hypertension? Am J Med . 1988;;84( (suppl 3A) ):136-139.
79 +
Hüting J, Mitrovic V, Thormann J, Bahavar H, Schlepper M.  Left ventricular muscle mass and diastolic function in patients with essential hypertension under long-term clonidine monotherapy. Clin Cardiol . 1991;;14:134-140.
80 +
Weinstein M, Hilewitz H, Rogel S.  The effect of single-dose methyldopa and diuretic on BP and left ventricular mass. Arch Intern Med . 1984;;144:1629-1632.
81 +
McMahon FG, Michael R, Ryan JR, LaCorte WJ, Jain A.  Regression of left ventricular hypertrophy in nineteen hypertensive patients treated with clonidine for eighteen months: a prospective study.  In: Weber MA, Drayer JIM, Kolloch R, eds. Low Dose Oral and Transdermal Therapy of Hypertension . Darmstadt, Germany: Steinkopff; 1985;:81-89.
82 +
Simpson P, McGrath A.  Norepinephrine-stimulated hypertrophy of cultured rat myocardial cells is an alpha1 adrenergic response. J Clin Invest . 1983;;72:732-736.
83 +
Ikeda U, Tsuruya Y, Yaginuma T.  α1-Adrenergic stimulation is coupled to cardiac myocyte hypertrophy. Am J Physiol . 1991;;260:H953-H956.
84 +
Schobel HP, Langenfeld M, Gatzka C, Schmieder RE.  Treatment and post-treatment effects of alpha- versus beta-receptor blockers on left ventricular structure and function in essential hypertension. Am Heart J . In press.
85 +
Denolle T, Chatellier G, Julien J, Battaglia C, Luo P, Plouin PF.  Left ventricular mass and geometry before and after etiologic treatment in renovascular hypertension, aldosterone-producing adenoma, and pheochromocytoma. Am J Hypertens . 1993;;6:907-913.
86 +
Himelman RB, Landzberg JS, Simonson JS, et al.  Cardiac consequences of renal transplantation. J Am Coll Cardiol . 1988;;12:915-923.
87 +
Fagerberg B, Wikstrand J, Berglund G, Hartford M, Ljungman S, Wendelhag I.  Withdrawal of antihypertensive drug treatment: time-course for redevelopment of hypertension and effects upon left ventricular mass. J Hypertens . 1992;;10:587-593.
88 +
Easterbrook PJ, Berlin JA, Copalan R, Matthews DR.  Publication bias in clinical research. Lancet . 1991;;337:867-872.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Messerli FH.  Going to the heart of the matter. Circulation . 1990;;81:1128-1135.
2 +
Mensah GA, Pappas TW, Koren MJ, Ulin RJ, Laragh JH, Devereux RB.  Comparison of classification to hypertension severity by blood pressure level and World Health Organization criteria for prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension. J Hypertens . 1993;;11:1429-1440.
3 +
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.
4 +
Levy D, Anderson KM, Savage DD, Kannel WB, Christiansen JC, Castelli WP.  Echo-cardiographically detected left ventricular hypertrophy: prevalence and risk factors: the Framingham Heart Study. Ann Intern Med . 1988;;108:7-13.
5 +
Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH.  Relation to left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med . 1991;;114:345-352.
6 +
Silberberg JS, Barre PE, Prichard SS, Snidermann AD.  Impact of left ventricular hypertrophy as survival of end-stage renal disease. Kidney Int . 1989;;36:286-290.
7 +
Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS.  The prognostic role of left ventricular artery disease. Ann Intern Med . 1992;;117:831-835.
8 +
Strauer BE.  Ventricular functions and coronary hemodynamics in hypertensive heart disease. Am J Cardiol . 1979;;44:999-1006.
9 +
Messerli FH, Ventura HO, Elizardi DJ, Dunn FG, Frohlich ED.  Hypertension and sudden death: increased ventricular ectopy activity in left ventricular hypertrophy. Am J Med . 1984;;77:18-22.
10 +
de Simone G, Devereux RB, Roman MJ, et al.  Assessment of left ventricular function by the mid-wall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol . 1994;;23:1444-1451.
11 +
Tubau JF, Szlachcic J, Braun S, Massie BM.  Impaired left ventricular functional reserve in hypertensive patients with left ventricular hypertrophy. Hypertension . 1989;;14:1-8.
12 +
Smith VE, Schulman P, Karimeddini MK, White WB, Meeran MK, Katz AM.  Rapid ventricular filling in left ventricular hypertrophy, II: pathologic hypertrophy. J Am Coll Cardiol . 1985;;5:862-868.
13 +
Koren MJ, Ulin R, Laragh JH, Devereux RB.  Reduction of left ventricular mass during treatment of essential hypertension is associated with improved prognosis. Am J Hypertens . 1991;;4:1A.
14 +
Yurenev AP, Dyakonova HG, Novkov ID, et al.  Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Am J Hypertens . 1992;;5:5182-5189.
15 +
Messerli FH, Nunez BD, Ventura HO, Snyder DW.  Overweight and sudden death: increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med . 1987;;147:1725-1728.
16 +
Schmieder RE, Messerli FH, Garavaglia GE, Nunez BD.  Dietary salt intake: a determinant of cardiac involvement in essential hypertension. Circulation . 1988;;78:951-956.
17 +
Liebson P, Prineas R, Grandits G, Dianzumba S, Grimm R, for TOMHS Research Group.  Variables associated with regression of left ventricular mass (LVM) in the Treatment of Mild Hypertension Study (TOMHS). Circulation . 1992;;85( (suppl 1) ):599.
18 +
Jul AM, Karanko HM.  Effects of left ventricular hypertrophy of long-term nonpharmacological treatment with sodium restriction in mild-to-moderate essential hypertension. Circulation . 1994;;89:1023-1031.
19 +
Alpert MA, Terry BE, Kelly DL.  Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol . 1985;;55:783-786.
20 +
MacMahon SW, Wilcken DEL, Macdonald GJ.  The effect of weight reduction on left ventricular mass: a randomized controlled trial in young, overweight hypertensive patients. N Engl J Med . 1986;; 314:334-339.
21 +
Jennings G, Dart A, Meredith I, Korner P, Laufer E, Dewar E.  Effects of exercise and other nonpharmacological measures on blood pressure and cardiac hypertrophy. J Cardiovasc Pharmacol . 1991;;17( (suppl 2) ):570-574.
22 +
Kelemen MH, Effron MB, Valenti SA, Stewart KJ.  Exercise training combined with antihypertensive drug therapy. JAMA . 1990;;263:2766-2771.
23 +
Devereux RB.  Angiotensin converting enzyme inhibition and regression of hypertensive left ventricular hypertrophy.  In: MacGregor GA, Severs PS, eds. Current Advances in ACE Inhibition 2 . Edinburgh, Scotland: Churchill Livingstone; 1991;:43-52.
24 +
Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC.  Meta-analyses of randomized controlled trials. N Engl J Med . 1987;;316:450-455.
25 +
Devereux RB.  Detection of left ventricular hypertrophy by M-mode echocardiography: anatomic validation, standardization, and comparison to other methods. Hypertension . 1987;;9( (suppl II) ):II-19—II-26.
26 +
Schmieder R, Messerli FH, Sturgill D, Garavaglia GE, Nunez BD.  Cardiac performance after reduction of myocardial hypertrophy. Am J Med . 1989;;87:22-27.
27 +
1993 Joint National Committee.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V). Arch Intern Med . 1993;;153:154-183.
28 +
Kaplan NM, Liebermann E.  Treatment of hypertension: drug therapy.  In: Kaplan NM, ed. Clinical Hypertension . 5th ed. Baltimore, Md: Williams & Wilkins; 1990;:182-267.
29 +
Dickersin K, Hewitt P, Mutch L, Chalmers I, Chalmers TC.  Revising the literature: comparison of MEDLINE searching with a perinatal clinical trials database. Control Clin Trials . 1985;;6:306-317.
30 +
Christensen R. Plane Answers to Complex Questions: The Theory of Linear Models . New York, NY: Springer Publishing Co; 1987;:22-25, 53-55.
31 +
Norusis MJ. SPSS for Windows: Advanced Statistics Release 6.0 . Chicago, Ill: SPSS Inc; 1993;.
32 +
Agabiti-Rosei E, Ambrosioni E, Finardi G, et al.  Perindopril versus captopril: efficacy and acceptability in an Italian multi center trial. Am J Med . 1992;;92( (suppl 4B) ):795-783.
33 +
Carr AA, Prisant LM.  The new calcium antagonist isradipine: effect on blood pressure and the left ventricle in black hypertensive patients. Am J Hypertens . 1990;;3:8-15.
34 +
Chan TYK, Woo KS, Nicholls MG.  The application of nebivolol in essential hypertension. Int J Cardiol . 1992;;35:387-395.
35 +
Dahlöf B, Hansson L.  Regression of left ventricular hypertrophy in previously untreated essential hypertension: different effects of enalapril and hydrochlorothiazide. J Hypertens . 1992;;10:1513-1524.
36 +
de Simone G, Ferrara LA, Di Lorenzo L, Lauria R, Fasano ML.  Effects of slow-release nifedipine on left ventricular mass and systolic function in mild or moderate hypertension. Curr Ther Res . 1984;;36:537-544.
37 +
de Simone G, Costantino G, Soro S, et al.  Effects of nicardipine on left ventricular hemodynamic patterns in systemic hypertension. Am J Hypertens . 1989;;2:139-145.
38 +
Dittrich HC, Adler J, Ong J, Reitman M, Weber M, Ziegler M.  Effects of sustained-release nicardipine on regression of left ventricular hypertrophy in systemic hypertension. Am J Cardiol . 1992;; 69:1559-1564.
39 +
Fernandez PG, Kim BK, Snedden W, Nolan R, Ko P.  Left ventricular changes after chronic therapy with enalapril maleate in moderate to severe hypertensive patients. Curr Med Res Opin . 1984;;9:170-183.
40 +
Ferrara LA, Fasano ML, de Simone G, Soro S, Gagliardi R.  Antihypertensive and cardiovascular effects of nitrendipine. Clin Pharmacol Ther . 1985;; 38:434-438.
41 +
Ferrara LA, de Simone G, Mancini M, Fasano ML, Pasanisi F, Vallone G.  Changes in left ventricular mass during a double-blind study with chlorthalidone and slow-release nifedipine. Eur J Clin Pharmacol . 1984;;27:525-528.
42 +
Frishman WH, Glasser SP, Strom JA, Schoenberger JA, Liebson P, Poland MP.  Effects of dilevalol, metroprolol and atenolol on left ventricular mass and function in nonelderly and elderly hypertensive patients. Am J Cardiol . 1989;;63:691-741.
43 +
Genovesi-Ebert A, Marabotti C, Palombo C, et al.  Effect of a new multifactorial antihypertensive on heart morphology and function in mild to moderate essential arterial hypertension. Eur Heart J . 1992;;13( (suppl A) ):45-48.
44 +
Giles TD, Sander GE, Roffidal LC, Thomas MG, Given MB, Quiroz AC.  Comparison of nitrendipine and hydrochlorothiazide for systemic hypertension. Am J Cardiol . 1987;;60:103-106.
45 +
Glasser SP, Koehn DK, Powell R.  Regression of left ventricular hypertrophy in treated hypertensive patients with dilevalol and metoprolol. J Clin Pharmacol . 1989;;29:791-797.
46 +
González-Fernández RA, Rivera M, Rodriguez PJ, et al.  Prevalence of ectopic ventricular activity after left ventricular mass regression. Am J Hypertens . 1993;;6:308-313.
47 +
González-Fernández RA, Altieri PI, Fernández-Martinez J, Lugo JE.  Prevalence of ventricular arrhythmias after left ventricular mass regression in the elderly. Cardiol Elderly . 1993;;1:185-190.
48 +
Gosse P, Roudaut R, Dallocchio M.  Effets du vérapamil et de la nifédipine sur la pression artérielle au repos et à léffort et la masse ventriculaire gauche. Arch Mal Coeur . 1992;;85:1249-1252.
49 +
Graettinger WF, Lipson JL, Klein RC, Cheung DC, Weber MA.  Comparison of antihypertensive therapies by noninvasive techniques. Chest . 1989;;96: 74-79.
50 +
Grandi AM, Venco A, Barzizza F, et al.  Double-blind comparison of perindopril and captopril in hypertension. Am J Hypertens . 1991;;4:516-520.
51 +
Leehey DJ, Hartman E.  Comparison of diltiazem and hydrochlorothiazide for treatment of patients 60 years of age or older with systemic hypertension. Am J Cardiol . 1988;;62:1218-1223.
52 +
Leonetti G, Fogari R, Mazzola C, Mangiameli S, Castello C.  Comparison of the effects on blood pressure and left ventricular hypertrophy of lacidipine and hydrochlorothiazide in hypertensive patients. J Hypertens . 1991;;9( (suppl 3) ):529-531.
53 +
Licata G, Scaglione R, Capuana G, et al.  Mediumterm doubleblind study of indenolol in hypertensive patients. Curr Ther Res . 1989;;46:103-110.
54 +
López NC, Corral JL, Rincón LA, et al.  Nitrendipine and atenolol in essential hypertension in young and middle-aged patients. J Cardiovasc Pharmacol . 1991;;18( (suppl 1) ):S101-S105.
55 +
Otterstad JE, Froeland G, Wasenuis Soeyland AK, Knutsen KM, Ekeli T.  Changes in left ventricular dimensions and systolic function in 100 mildly hypertensive men during one year's treatment with atenolol vs. hydrochlorothiazide and amiloride (Moduretic). J Intern Med . 1992;;231:493-501.
56 +
Schneeweiss A, Rosenthal J, Marmor A.  Comparative evaluation of the acute and chronic effects of cilazapril and hydrochlorothiazide on diastolic cardiac function in hypertensive patients. J Hum Hypertens . 1990;;4:535-539.
57 +
Schulman SP, Weiss JL, Becker LC, et al.  The effects of antihypertensive therapy on left ventricular mass in elderly patients. N Engl J Med . 1990;;322:1350-1356.
58 +
Schulte KL, Meyer-Sabellek W, Liederwald K, van Gemmeren D, Lenz T, Gotzen R.  Relation of regression of left ventricular hypertrophy to changes in ambulatory blood pressure after long-term therapy with perindopril versus nifedipine. Am J Cardiol . 1992;;70:468-473.
59 +
Senior R, Imbs JI, Bory M, et al.  Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study. J Cardiovasc Pharmacol . 1993;;22( (suppl 6) ):S106-S110.
60 +
Shigematsu S, Haramatsu K, Aizawa T, et al.  Regression of left ventricular hypertrophy in patients with essential hypertension. Cardiology . 1990;; 77:280-286.
61 +
Szlachcic J, Tubau JF, Vollmer C, Massie BM.  Effect of diltiazem on left ventricular mass and diastolic filling in mild to moderate hypertension. Am J Cardiol . 1989;;63:198-201.
62 +
Szlachcic J, Hall WD, Tubau JF, et al.  Left ventricular hypertrophy reversal with labetalol and propranolol. Cardiovasc Drug Ther . 1990;;4:427-434.
63 +
van Leeuwen JTM, ten Berge BS, Hamer JPM, et al.  Comparative study of lisinopril and metoprolol in mild to moderate hypertension: antihypertensive efficacy using office, ambulatory and exercise blood pressure and effect of treatment on left ventricular mass and exercise tolerance. J Drug Dev . 1992;;5:119-127.
64 +
Weiss RJ, Bent B.  Diltiazem-induced left ventricular mass regression in hypertensive patients. J Clin Hypertens . 1987;;3:135-143.
65 +
Wetzchewald D, Klaus D, Garanin G, Lohr E, Hoffmann J.  Regression of left ventricular hypertrophy during long-term antihypertensive treatment—a comparison between felodipine and the combination of felodipine and metroprolol. J Intern Med . 1992;;231:303-308.
66 +
Steensgaard-Hansen F, Carlsen JE.  Effects of long term treatment with pinacidil and nifedipine on left ventricular anatomy and function in patients with mild to moderate systemic hypertension. Drugs . 1988;;36( (suppl 7) ):70-76.
67 +
Leonetti G, Fogari R, Mazzola C, et al.  Effects of blood pressure reduction with trandolapril and enalapril on left ventricular hypertrophy and exercise tolerance. J Hypertens . 1993;;11:5356-5357.
68 +
Lièvre M, Guéret P, Gayet C, et al, on behalf of the HYCAR Study Group.  Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. Hypertension . 1995;;25:92-97.
69 +
Vyssoulis GP, Valiouli MA, Karpanou EA, Toutouzas PK.  Left ventricular and aortic root structure and function changes with beta blocker antihypertensive therapy: a one-year double blind study of celiprolol and metoprolol. Int J Cardiol . 1995;;49:45-54.
70 +
Neaton JD, Grimm RH Jr, Prineas RJ, et al, for the Treatment of Mild Hypertension Study Group.  Treatment of Mild Hypertension Study: final results. JAMA . 1993;;270:718-724.
71 +
Dahlöf B, Pennert K, Hansson L.  Reversal of left ventricular hypertrophy in hypertensive patients: a meta-analysis of 109 treatment studies. Am J Hypertens . 1992;;5:95-110.
72 +
Cruickshank J, Lewis J, Moore V, Dodd C.  Reversibility of left ventricular hypertrophy of different types of antihypertensive therapy. J Hum Hypertens . 1992;;6:85-90.
73 +
Eagle KA, Blank DJ, Agniar E, Firth LM.  Economic impact of regression of left ventricular hypertrophy by antihypertensive drugs. J Hum Hypertens . 1993;;7:341-351.
74 +
Böhlen L, Weidman P, de Courten M, Erne P, Shaw S.  Antihypertensive drug effects on left ventricular hypertrophy. J Hypertens . 1994;;12( (suppl 3) ): S140.
75 +
Agabiti-Rosei E, Ambrosioni E, dal Palù C, Muiesan ML, Zanchetti A, on behalf of the RACE Study Group.  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. J Hypertens . 1995;;13:1325-1334.
76 +
Grodzicki T, Messerli FH, Savia F, Aristizabal D.  Determinants of left ventricular mass reduction in essential hypertension. Circulation . 1992;;86( (suppl 1) ): 64.
77 +
Schunkert H, Hense HW, Holmer SR, et al.  Association between a deletion polymorphism of the angiotensin-converting-enzyme gene and left ventricular hypertrophy. N Engl J Med . 1994;;330: 1634-1638.
78 +
Schmieder R, Messerli FH, Garavaglia GE, Nunez BD, MacPhee AA, Re NR.  Does the renin-angiotensin-aldosterone system modify cardiac structure and function in essential hypertension? Am J Med . 1988;;84( (suppl 3A) ):136-139.
79 +
Hüting J, Mitrovic V, Thormann J, Bahavar H, Schlepper M.  Left ventricular muscle mass and diastolic function in patients with essential hypertension under long-term clonidine monotherapy. Clin Cardiol . 1991;;14:134-140.
80 +
Weinstein M, Hilewitz H, Rogel S.  The effect of single-dose methyldopa and diuretic on BP and left ventricular mass. Arch Intern Med . 1984;;144:1629-1632.
81 +
McMahon FG, Michael R, Ryan JR, LaCorte WJ, Jain A.  Regression of left ventricular hypertrophy in nineteen hypertensive patients treated with clonidine for eighteen months: a prospective study.  In: Weber MA, Drayer JIM, Kolloch R, eds. Low Dose Oral and Transdermal Therapy of Hypertension . Darmstadt, Germany: Steinkopff; 1985;:81-89.
82 +
Simpson P, McGrath A.  Norepinephrine-stimulated hypertrophy of cultured rat myocardial cells is an alpha1 adrenergic response. J Clin Invest . 1983;;72:732-736.
83 +
Ikeda U, Tsuruya Y, Yaginuma T.  α1-Adrenergic stimulation is coupled to cardiac myocyte hypertrophy. Am J Physiol . 1991;;260:H953-H956.
84 +
Schobel HP, Langenfeld M, Gatzka C, Schmieder RE.  Treatment and post-treatment effects of alpha- versus beta-receptor blockers on left ventricular structure and function in essential hypertension. Am Heart J . In press.
85 +
Denolle T, Chatellier G, Julien J, Battaglia C, Luo P, Plouin PF.  Left ventricular mass and geometry before and after etiologic treatment in renovascular hypertension, aldosterone-producing adenoma, and pheochromocytoma. Am J Hypertens . 1993;;6:907-913.
86 +
Himelman RB, Landzberg JS, Simonson JS, et al.  Cardiac consequences of renal transplantation. J Am Coll Cardiol . 1988;;12:915-923.
87 +
Fagerberg B, Wikstrand J, Berglund G, Hartford M, Ljungman S, Wendelhag I.  Withdrawal of antihypertensive drug treatment: time-course for redevelopment of hypertension and effects upon left ventricular mass. J Hypertens . 1992;;10:587-593.
88 +
Easterbrook PJ, Berlin JA, Copalan R, Matthews DR.  Publication bias in clinical research. Lancet . 1991;;337:867-872.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems