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(Circulation. 2001;104:1248.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Effects of Once-Daily Angiotensin-Converting Enzyme Inhibition and Calcium Channel Blockade-Based Antihypertensive Treatment Regimens on Left Ventricular Hypertrophy and Diastolic Filling in Hypertension

The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) Trial

Richard B. Devereux, MD; Vittorio Palmieri, MD; Norman Sharpe, MD; Vincent De Quattro, MD; Jonathan N. Bella, MD; Giovanni de Simone, MD; J. Findlay Walker, MD; Rebecca T. Hahn, MD; Björn Dahlöf, MD, PhD

From Cornell Medical Center, New York, NY (R.B.D., V.P., J.N.B., G.d.S., R.T.H.); Auckland Hospital, Aukland, New Zealand (N.S.); University of Southern California, Los Angeles (V.D.Q.); Merck & Co, Whitehouse Station, NJ (J.F.W.); and University of Göteborg, Göteborg, Sweden (B.D.).

Correspondence to Richard B. Devereux, MD, Division of Cardiology, New York Presbyterian Hospital, 525 East 68th St, NY, NY, 10021. E-mail rbdevere{at}med.cornell.edu

Background— The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) study was designed to test whether enalapril achieves greater left ventricular (LV) mass reduction than does a nifedipine gastrointestinal treatment system by a prognostically meaningful degree on a population basis (10 g/m²).

Methods and Results— An ethnically diverse population of 303 men and women with essential hypertension and increased LV mass at screening echocardiography were enrolled at clinical centers on 4 continents and studied by echocardiography at baseline and after 6- and 12-month randomized therapy. Clinical examination and blinded echocardiogram readings 48 weeks after study entry in an intention-to-treat analysis of 113 enalapril-treated and 122 nifedipine-treated patients revealed similar reductions in systolic/diastolic pressure (-22/12 versus -21/13 mm Hg) and LV mass index (-15 versus -17g/m², both P>0.20). No significant between-treatment difference was detected in population subsets defined by monotherapy treatment, sex, age, race, or severity of baseline hypertrophy. Similarly, there was no between-treatment difference in change in velocities of early diastolic or atrial phase transmitral blood flow. More enalapril-treated than nifedipine-treated patients required supplemental treatment with hydrochlorothiazide (59% versus 34%, P<0.001) but not atenolol (27% versus 22%, NS).

Conclusions— Once-daily antihypertensive treatment with enalapril or long-acting nifedipine, plus adjunctive hydrochlorothiazide and atenolol when needed to control blood pressure, both had moderately beneficial and statistically indistinguishable effects on regression of LV hypertrophy.

Key Words: angiotensin • calcium • trials • echocardiography • hypertension • hypertrophy

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