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Irbesartan More Effective Than Amlodipine in Reducing Left Ventricular Mass Index

Irbesartan appears to be more effective than amlodipine in reducing left ventricular mass index (LVMI) in hypertensive patients with left ventricular hypertrophy (LVH) despite a similar effect on blood pressure (BP), new research suggests.

Several studies have established that LVH is a powerful BP-independent cardiovascular risk factor; however, not all antihypertensive drugs can reverse LVH.

Carlo Gaudio, MD, with the University of Rome, Italy, and colleagues assessed the effects of irbesartan and amlodipine on LVMI in patients with mild to moderate untreated hypertension and echocardiographically determined LVH.

Sixty hypertensive patients (35 men, 25 women; mean age, 52.8 years ± 12.6) with diastolic BP >/= 100 mm Hg were randomised to receive irbesartan 150 mg once daily or amlodipine 5 mg once daily for a 4-week titration period.

Dosage was increased to irbesartan 300 mg once daily or amlodipine 10 mg once daily in the event that sitting diastolic BP remained > 90 mmHg after 2 weeks. More than half of the patients in both groups required dosage doubling.

After the titration period, only the responders (sitting diastolic BP </= 90 mmHg) entered a 5-month maintenance period. After 3 months, echocardiographically estimated LVMI decreased by 23.2% in the irbesartan-treated patients and 11.4% in the amlodipine-treated patients. Adjusted mean difference was 11.8% in favour of irbesartan (P < .0001).

After 6 months, the LVMI decreased by 24.7% in the irbesartan-treated patients and 13.0% in the amlodipine-treated patients, with an adjusted mean difference of 11.6% in favour of irbesartan (P < .0001).

"Our findings are consistent with the main conclusions of several recent studies that assessed the efficacy of the angiotensin receptor antagonists on BP reduction and LVMI regression," the researchers conclude.

According to the researchers, the results suggest that irbesartan, and possibly other angiotensin receptor antagonists could play an important role in preventing cardiovascular complications and causing regression of target organ damage.



J Cardiovasc Pharmacol 2003;42:5:622-628. "Comparative effects of irbesartan versus amlodipine on left ventricular mass index in hypertensive patients with left ventricular hypertrophy"

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