Real role of β-blockers in regression of left ventricular mass in hypertension patients

Abstract

Background: Left ventricular hypertrophy (LVH) is commonly present in patients with hypertension (HT). According to the expert consensus document from American, angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blockers (ARBs) were recommended as 1st-line therapeutic drugs. However, none noticed the different efficacy between fat-soluble and selective b1-receptor blockers (FS-b-B) and other b-blockers on regression of LVH before. The aim of this analysis was to compare the efficacy of FS-b-B with the other 4 different classes of antihypertensive drugs (ACEI, ARBs, calcium channel blockers [CCBs], and diuretics) on regression of LVH.Methods: Relative trials were identified in the PubMed, Web of Science, OVID EBM Reviews and Cochrane databases, and the relevant papers were examined. We performed both traditional and Bayesian meta-analysis of randomized controlled trials (RCTs) about the regression of LVH. Sensitivity analysis and regression analysis were performed to explore possible sources of heterogeneity. Inconsistency analysis was performed to check whether the analysis of the trials in the network was indeed consistent.Results: A total of 41 RCTs involving 2566 patients with HT and LVH were included in this analysis. Bayesian network meta-analysis indicated no statistically significant differences between these groups: FS-b-B and ACEI (MD, À7.09; 95% CI, À14.99, 1.27); FS-b-B and ARB (MD, À2.66; 95% Cl, À12.02, 6.31). Although FS-b-B showed greater efficacy when compared with diuretic (MD, 13.04; 95% CI, 3.38, 22.59) or CCB (MD, 10.90; 95% CI, 1.98, 19.49). The probabilities of being among the most efficacious treatments were: FS-b-B (72%), ARB (27%), ACEI (0.01%), CCB (0.00%), and diuretic (0.00%). Conclusion:Evidence from our analysis reveals that FS-b-B have potential to become 1st-line therapeutic drugs in HT and LVH patients. However, the real efficacy of FS-b-B on regression of LVH should be confirmed by further large, high quality trials considering the limitation of the study number.Abbreviations: ACEI = angiotensin-converting enzyme inhibitor, ARB = angiotensin receptor blocker, CCB = calcium channel blocker, FS-b-B = fat-soluble and selective b1-receptor blockers, LVH = left ventricular hypertrophy, LVM = left ventricular mass, LVMI = left ventricular mass index.

Comparative efficacy of different types of antihypertensive drugs in reversing left ventricular hypertrophy as determined with echocardiography in hypertensive patients: A network meta‐analysis of randomized controlled trials

“…Brigitte et al have shown that it takes at least 100 days to reverse this process 70 . Therefore, the shorter intervention period in the previous meta‐analysis was insufficient to evaluate the possibility of reversing LVH with various antihypertensive drugs 61 . Unlike previous meta‐analyses, the shortest observation period in our study was three months, and network meta‐analysis suggested that ARB might be the preferred antihypertensive drug to reverse LVH.…”

“…Prevention or reversal of LVH has been shown to reduce the risk of cardiovascular events in hypertensive patients 59,60 . Although several clinical trials and meta‐analyses have compared the effects of different classes of antihypertensive drugs on ventricular hypertrophy, the usefulness of the results is limited by their inadequate design and inappropriate methods 61,62 . Although meta‐analyses can improve the statistical power and provide more accurate estimates of the effect value, the results depend largely on the criteria for inclusion in the study 63,64 .…”

The impact of mTOR inhibitors in the regression of left ventricular hypertrophy in elderly kidney transplant recipients

“…When LVH regresses to normal level, spontaneously or due to therapy, cardiovascular risk is substantially reduced, independently of levels of blood pressure control. 19 Many factors can contribute to this reversal effects, like blood pressure control, 20 time on dialysis 21,22 use of ACE inhibitors, 23,24,25 ARBs, 23,25,26 β-blockers, 23,25,27 and other antihypertensive drugs. 20,23,27 We had the caution to analyze the frequency of all these features in both groups with very similar results.…”

“…19 Many factors can contribute to this reversal effects, like blood pressure control, 20 time on dialysis 21,22 use of ACE inhibitors, 23,24,25 ARBs, 23,25,26 β-blockers, 23,25,27 and other antihypertensive drugs. 20,23,27 We had the caution to analyze the frequency of all these features in both groups with very similar results. We have also analyzed the use of metformin, due to its effect in the reversal of LVH 28 with a frequency of use similar in both groups.…”

Real role of β-blockers in regression of left ventricular mass in hypertension patients

“…In the article, “Real role of β-blockers in regression of left ventricular mass in hypertension patients: Bayesian network meta-analysis”, [1] which appeared in Volume 96, Issue 10 of Medicine , Drs FuWei Xing, Jingzhou Jiang, Anli Tang and Yili Chen should also be affiliated with Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China.…”