Effects of Losartan Titrated to Losartan/Hydrochlorothiazide and Amlodipine on Left Ventricular Mass in Patients with Mild-to-Moderate Hypertension

Abstract

To study the effects of the angiotensin II receptor antagonist Losartan and Amlodipine on left ventricular mass (LVM), we performed blood pressure measurements and transthoracic echocardiographies at baseline. After a 4-week placebo run-in period, 25 patients with mild-to-moderate essential hypertension were randomly allocated to active treatment with Losartan 50 mg titrated to Losartan 50 mg/hydrochlorothiazide (HCT) 12.5 mg (n = 11) or Amlodipine 5 mg titrated to 10 mg (n = 14) for 16 weeks. After treatment, blood pressure decreased significantly in both groups. LVM and LVM index (mean ± SD/median) in the Losartan group at baseline were 311 ± 101/288 g and 163 ± 55/150 g/m² and decreased significantly to 252 ± 25/255 g and 133 ± 22/128 g/m² (p = 0.003 for LVM; p = 0.01 for LVM index) after 16 weeks of active treatment. In the Amlodipine group LVM and LVM index decreased from 259 ± 47/243 g and 136 ± 25/ 131 g/m² to 240 ± 42/234 g and 126 ± 24/123 g/m² (n.s.). In conclusion, LVM decreased significantly as early as 16 weeks after initiation of antihypertensive treatment with the Angiotensin II antagonist Losartan.

Effects of Telmisartan and Losartan on Left Ventricular Mass in Mild-to-Moderate Hypertension

“…This is also the first randomized trial on reduction of LVM by telmisartan in human hypertensives. LVM reduction in other studies on ARBs [2,3,6] was greater in comparison to the LVM reduction in our study. In contrast to other studies that included only patients with echocardiographic [6], ECG LVH [1] or with a higher prevalence and severity of LVH [2,3], we studied general medical outpatients with newly detected hypertension with a lower prevalence of LVH (30%) and a lower baseline LVM.…”

“…Losartan significantly reduces left ventricular mass (LVM) [1][2][3] but has a limited duration of action and a small distribution volume. This may limit the effectiveness of losartan in reducing LVM.…”

Blockade of Angiotensin II Type 1 Receptor Improves the Arrhythmia Morbidity in Mice With Left Ventricular Hypertrophy

“…Both electrophysiological and structural remodeling contributes to maintaining the arrhythmia in LVH. 13,33 In our experimental model with TAC, we observed that chronic treatment with candesartan did normalize several electrophysiological parameters such as PR interval, ERP-AVN, SNRT, CSNRT AV-WPCL and VA-WPCL (Table 3). The TAC procedure also prolonged ERP-RV, and candesartan returned this value to the control level, although there was no statistical significance.…”

Effect of losartan and spironolactone on left ventricular mass and heart sympathetic activity in prehypertensive obese subjects: a 16-week randomized trial

“…Martina et al, 26 in patients with mild-to-moderate hypertension reported that losartan 50 mg/hydrochlorothiazide 12.5 mg significantly reduced LVM after 16 weeks of treatment, whereas the reduction in LVM seen in the amlodipine group was not significantly different. Kanno et al, 27 in 24 diabetic patients with end-stage renal disease reported that losartan decreased LVM index, posterior wall thickness, and intraventricular wall thickness in spite of a similar reduction of blood pressure in patients receiving placebo; and this effect was observed since 4 months of treatment.…”