Three-Dimensional Echocardiographic and Magnetic Resonance Assessment of the Effect of Telmisartan Compared With Carvedilol on Left Ventricular MassA Multicenter, Randomized, Longitudinal Study

Galzerano, Domenico; Tammaro, Paolo; Viscovo, Luca Del; Lama, Diana; Galzerano, António; Breglio, R; Tuccillo, Bernardino; Paolisso, Giuseppe; Capogrosso, Paolo

doi:10.1016/j.amjhyper.2005.06.011

Cited by 67 publications

(42 citation statements)

References 26 publications

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“…However, it cannot be excluded that the results would be more favorable with third-generation ␤-blockers with potentially beneficial ancillary properties, but we identified only 1 comparative study with nebivolol 79 and 1 with carvedilol. 80 In the overall analysis, the regression of LVM by angiotensin receptor blockers is significantly better than with the other drugs statistically combined. Even after the exclusion of ␤-blockers and comparison with the other 3 classes, the difference in favor of angiotensin receptor blockers is close to statistical significance (Pϭ0.06) and amounts to 4%, although part of the difference may be related to better BP control.…”

Section: Fagard Et Al Drugs and Regression Of Left Ventricular Massmentioning

confidence: 95%

Regression of Left Ventricular Mass by Antihypertensive Treatment

et al. 2009

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Abstract-Blood pressure-lowering therapy reduces left ventricular mass, but the question of whether differences exist among drug classes has not been fully resolved. Our aim was to compare the effects of diuretics, ␤-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers on left ventricular mass regression in patients with hypertension on the basis of prospective, randomized comparative studies. We performed meta-analyses, involving pooled pairwise comparisons of the drug classes and of each class versus other classes statistically combined, and meta-regression analyses to identify the determinants of the regression. The 75 relevant publications involved 84 pairwise comparisons and 6001 patients. Regression of left ventricular mass was significantly less (Pϭ0.01) with ␤-blockers (9.8%) than with angiotensin receptor blockers (12.5%), but none of the other analyzable pairwise comparisons between drug classes revealed significant differences (PϾ0.10). In addition, ␤-blockers showed less regression than the other 4 classes statistically combined (PϽ0.01), and regression was more pronounced with angiotensin receptor blockers versus the others (PϽ0.01). In multivariable meta-regression analysis on all of the treatment arms, ␤-blocker treatment was a significant and negative predictor of the regression (Ϫ3.6%; PϽ0.01), but this was not the case for the other drug classes, including angiotensin receptor blockers. In conclusion, ␤-blockers show less regression of left ventricular mass, whereas angiotensin receptor blockers may induce larger regression. The inferiority of ␤-blockers appears to be more convincing than the superiority of angiotensin receptor blockers. Key Words: angiotensin-converting enzyme inhibitor Ⅲ angiotensin receptor blocker Ⅲ ␤-blocker Ⅲ calcium channel blocker Ⅲ diuretic Ⅲ left ventricular mass Ⅲ meta-analysis T here is little doubt that blood pressure (BP)-lowering therapy reduces left ventricular (LV) mass (LVM) in patients with hypertension in comparison with placebo treatment. 1-3 However, the question of whether differences exist among drug classes remains a matter of debate. Meta-analyses have suggested that angiotensin-converting enzyme (ACE) inhibitors might be more effective than other first-line therapies 1,2 ; that ACE inhibitors and, to a lesser extent, calcium channel blockers, rather than diuretics and ␤-blockers, emerge as first-line candidates to reduce LVM 3 ; and, more recently, that angiotensin receptor blockers also favorably reduce LVM. 4 Advantages of the meta-analytic technique are the increased statistical power and the more accurate estimate of the magnitude of the effect, 5 but the results largely depend on the criteria for the inclusion of studies. In early meta-analyses on the regression of LVM, the majority of the included studies were open, uncontrolled, single-drug studies, which may seriously hamper their interpretation. 1,2 A subsequent meta-analysis 3 only included studies that compared different drug classe...

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Section: Fagard Et Al Drugs and Regression Of Left Ventricular Massmentioning

confidence: 95%

Regression of Left Ventricular Mass by Antihypertensive Treatment

et al. 2009

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“…those who have not had any previous episodes of AF, and those with paroxysmal or persistent AF who either do not need any antiarrhythmic therapy, or those with persistent AF who do require anti-arrhythmic therapy to maintain sinus rhythm following cardioversion). [16][17][18][19] Telmisartan has the longest half-life of any ARB (approximately 24 hours) 20 and has been shown to reduce left ventricular hypertrophy (LVH) in clinical studies of hypertensive patients, [21][22][23][24] as well as in the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE-I iNtolerant subjects with cardiovascular Disease (TRANSCEND) cardiovascular (CV) outcomes, although no reduction in new-onset AF was found. [25][26][27] The purpose of the present study was to assess the efficacy of an antihypertensive therapeutic dose of telmisartan (80 mg once daily) as compared with that of the β-blocker carvedilol (25 mg once daily), which has been shown to have clinically important anti-arrhythmic properties, [28][29][30][31][32] for the prevention of AF recurrence in a population of hypertensive patients with a recent history of AF and who were in sinus rhythm and who did not require anti-arrhythmic therapy.…”

Section: Introductionmentioning

confidence: 99%

A multicentre, randomized study of telmisartan versus carvedilol for prevention of atrial fibrillation recurrence in hypertensive patients

Galzerano

Michele

Paolisso³

et al. 2012

J Renin Angiotensin Aldosterone Syst

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Introduction: Atrial remodelling, leading to atrial fibrillation (AF), is mediated by the renin-angiotensin-aldosterone system. Methods: Mild hypertensive outpatients (systolic/diastolic blood pressure 140-159/90-99 mmHg) in sinus rhythm who had experienced ≥ 1 electrocardiogram (ECG)-documented AF episode in the previous six months received randomly telmisartan 80 mg/day or carvedilol 25 mg/day. Blood pressure and 24-hour ECG were monitored monthly for one year; patients were asked to report symptomatic AF episodes and to undergo an ECG as early as possible. Results: One hundred and thirty-two patients completed the study (telmisartan, n=70; carvedilol, n=62

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“…Another study compared telmisartan with carvedilol, a beta blocker with an additional vasodilatator effect: LVM reduction, evaluated with magnetic resonance, was greater in the telmisartan group [80].…”

Section: Drugs Acting On Sympathetic Nervous Systemmentioning

confidence: 98%

Anti-hypertensive drugs and left ventricular hypertrophy: a clinical update

et al. 2010

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Structural remodelling of the heart, known as left ventricular hypertrophy (LVH), is a consequence of systemic hypertension, and is associated with an increased risk of cardiovascular morbidity and mortality. Therefore, particular attention should be paid to the identification, prevention and treatment of this condition in hypertensive patients. LVH seems to benefit from all classes of anti-hypertensive drugs; however, antagonists of the renin-angiotensin-aldosterone system (RAAS) have demonstrated an additional benefit in the inhibition and reversal of myocardial interstitial fibrosis. Nevertheless, in evaluating the degree of arterial hypertension and organ damage, many neuro-hormonal systems are involved, primarily the sympathetic nervous system, thereby explaining the use of different classes of anti-hypertensive drugs to prevent or reduce LVH. The RAAS antagonists are actually the recommended anti-hypertensive agents to prevent organ damage in hypertensive subjects or in hypertensives with evidence of LVH to reduce cardiovascular mortality and morbidity.

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Three-Dimensional Echocardiographic and Magnetic Resonance Assessment of the Effect of Telmisartan Compared With Carvedilol on Left Ventricular MassA Multicenter, Randomized, Longitudinal Study

Abstract: The superior LVM regression with telmisartan versus carvedilol suggests telmisartan has a mechanism that may be beyond that of lowering BP in hypertensive patients.

Cited by 67 publications

References 26 publications

Regression of Left Ventricular Mass by Antihypertensive Treatment

Regression of Left Ventricular Mass by Antihypertensive Treatment

A multicentre, randomized study of telmisartan versus carvedilol for prevention of atrial fibrillation recurrence in hypertensive patients

Anti-hypertensive drugs and left ventricular hypertrophy: a clinical update

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