(Circulation. 1995;91:698-706.)
© 1995 American Heart Association, Inc.
Articles |
Comparison of Five Antihypertensive Monotherapies and Placebo for Change in Left Ventricular Mass in Patients Receiving Nutritional-Hygienic Therapy in the Treatment of Mild Hypertension Study (TOMHS)
From the Section of Cardiology, Department of Medicine, and the Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill; the Division of Biostatistics and the Division of Cardiovascular Diseases, Department of General Medicine, University of Minnesota, Minneapolis; the Department of Epidemiology and Public Health, University of Miami (Florida); the Noninvasive Laboratory, Allegheny General Hospital, Pittsburgh, Pa; and the Department of Community Health and Preventive Medicine, Northwestern University, Chicago, Ill.
Correspondence to Greg Grandits, Division of Biostatistics, University of Minnesota, 2221 University Ave, Suite 200, Minneapolis, MN 55414.
Background Increased left ventricular mass (LVM) by echocardiography is associated with increased risk of cardiovascular disease. Thus, it is of interest to compare the effects of both pharmacological and nonpharmacological approaches to the treatment of hypertension on reduction of LVM.
Methods and Results Changes in LV structure were assessed by
M-mode echocardiograms in a double-blind, placebo-controlled clinical
trial of 844 mild hypertensive participants randomized to
nutritional-hygienic (NH) intervention plus placebo or NH plus one of
five classes of antihypertensive agents: (1) diuretic (chlorthalidone),
(2) ß-blocker (acebutolol), (3) 
-antagonist (doxazosin mesylate),
(4) calcium antagonist (amlodipine maleate), or (5)
angiotensin-converting enzyme inhibitor (enalapril maleate).
Echocardiograms were performed at baseline, at 3 months, and annually
for 4 years. Changes in blood pressure averaged 16/12 mm Hg in the
active treatment groups and 9/9 mm Hg in the NH only group. All groups
showed significant decreases (10% to 15%) in LVM from baseline that
appeared at 3 months and continued for 48 months. The chlorthalidone
group experienced the greatest decrease at each follow-up visit
(average decrease, 34 g), although the differences from other groups
were modest (average decrease among 5 other groups, 24 to 27 g).
Participants randomized to NH intervention only had mean changes in LVM
similar to those in the participants randomized to NH intervention plus
pharmacological treatment. The greatest difference between groups was
seen at 12 months, with mean decreases ranging from 35 g
(chlorthalidone group) to 17 g (acebutolol group) (P=.001
comparing all groups). Within-group analysis showed that changes in
weight, urinary sodium excretion, and systolic BP were moderately
correlated with changes in LVM, being statistically significant in most
analyses.
Conclusions NH intervention with emphasis on weight loss and reduction of dietary sodium is as effective as NH intervention plus pharmacological treatment in reducing echocardiographically determined LVM, despite a smaller decrease in blood pressure in the NH intervention only group. A possible exception is that the addition of diuretic (chlorthalidone) may have a modest additional effect on reducing LVM.
Key Words: hypertension • antihypertensive agents • ventricles • lifestyle • echocardiography
This article has been cited by other articles:
 |
|
 |
|
  J. Varagic, E. D. Frohlich, D. Susic, J. Ahn, L. Matavelli, B. Lopez, and J. Diez AT1 receptor antagonism attenuates target organ effects of salt excess in SHRs without affecting pressure Am J Physiol Heart Circ Physiol, February 1, 2008; 294(2): H853 - H858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Phillips New-onset diabetes mellitus less deadly than elevated blood pressure?: following the evidence in the administration of thiazide diuretics. Arch Intern Med, November 13, 2006; 166(20): 2174 - 2176. [Full Text] [PDF]
|
|
|
|
 |
|
 P. A Meredith and J. Ostergren Review: From Hypertension to Heart Failure -- Are There Better Primary Prevention Strategies? Journal of Renin-Angiotensin-Aldosterone System, June 1, 2006; 7(2): 64 - 73. [Abstract] [PDF]
|
|
|
|
|
|
K. J. Stewart, A. C. Bacher, K. L. Turner, J. L. Fleg, P. S. Hees, E. P. Shapiro, M. Tayback, and P. Ouyang Effect of Exercise on Blood Pressure in Older Persons: A Randomized Controlled Trial Arch Intern Med, April 11, 2005; 165(7): 756 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Meneton, X. Jeunemaitre, H. E. de Wardener, and G. A. Macgregor Links Between Dietary Salt Intake, Renal Salt Handling, Blood Pressure, and Cardiovascular Diseases Physiol Rev, April 1, 2005; 85(2): 679 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. He, N. D. Markandu, G. A. Sagnella, H. E. de Wardener, and G. A. MacGregor Plasma Sodium: Ignored and Underestimated Hypertension, January 1, 2005; 45(1): 98 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. H. Cingolani, X.-P. Yang, Y.-H. Liu, M. Villanueva, N.-E. Rhaleb, and O. A. Carretero Reduction of Cardiac Fibrosis Decreases Systolic Performance Without Affecting Diastolic Function in Hypertensive Rats Hypertension, May 1, 2004; 43(5): 1067 - 1073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Harsha, F. M. Sacks, E. Obarzanek, L. P. Svetkey, P.-H. Lin, G. A. Bray, M. Aickin, P. R. Conlin, E. R. Miller III, and L. J. Appel Effect of Dietary Sodium Intake on Blood Lipids: Results From the DASH-Sodium Trial Hypertension, February 1, 2004; 43(2): 393 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Schlaich, D. M. Kaye, E. Lambert, M. Sommerville, F. Socratous, and M. D. Esler Relation Between Cardiac Sympathetic Activity and Hypertensive Left Ventricular Hypertrophy Circulation, August 5, 2003; 108(5): 560 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Flack, R. Peters, T. Shafi, H. Alrefai, S. A. Nasser, and E. Crook Prevention of Hypertension and Its Complications: Theoretical Basis and Guidelines for Treatment J. Am. Soc. Nephrol., July 1, 2003; 14(90002): S92 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.D. Struthers and J. Davies Should we add screening for and treating left ventricular hypertrophy to the management of all patients needing secondary prevention of cardiovascular disease? QJM, June 1, 2003; 96(6): 449 - 452. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Grandi, D. Imperiale, R. Santillo, E. Barlocco, A. Bertolini, L. Guasti, and A. Venco Aldosterone Antagonist Improves Diastolic Function in Essential Hypertension Hypertension, November 1, 2002; 40(5): 647 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Black, W. J. Elliott, M. A. Weber, W. H. Frishman, J. A. Strom, P. R. Liebson, C. T. Hwang, D. A. Ruff, R. Montoro, V. DeQuattro, et al. One-Year Study of Felodipine or Placebo for Stage 1 Isolated Systolic Hypertension Hypertension, November 1, 2001; 38(5): 1118 - 1123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Y.H. Lip Regression of Left Ventricular Hypertrophy and Improved Prognosis: Some HOPE Now...or Hype? Circulation, October 2, 2001; 104(14): 1582 - 1584. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Cohen Adverse Drug Effects, Compliance, and Initial Doses of Antihypertensive Drugs Recommended by the Joint National Committee vs the Physicians' Desk Reference Arch Intern Med, March 26, 2001; 161(6): 880 - 885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. H. Klungel, S. R. Heckbert, W. T. Longstreth Jr, C. D. Furberg, R. C. Kaplan, N. L. Smith, R. N. Lemaitre, H. G. M. Leufkens, A. de Boer, and B. M. Psaty Antihypertensive Drug Therapies and the Risk of Ischemic Stroke Arch Intern Med, January 8, 2001; 161(1): 37 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Kuperstein and Z. Sasson Effects of Antihypertensive Therapy on Glucose and Insulin Metabolism and on Left Ventricular Mass : A Randomized, Double-Blind, Controlled Study of 21 Obese Hypertensives Circulation, October 10, 2000; 102(15): 1802 - 1806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Brilla, R. C. Funck, and H. Rupp Lisinopril-Mediated Regression of Myocardial Fibrosis in Patients With Hypertensive Heart Disease Circulation, September 19, 2000; 102(12): 1388 - 1393. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The ALLHAT Officers and Coordinators for the ALLHA Major Cardiovascular Events in Hypertensive Patients Randomized to Doxazosin vs Chlorthalidone: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) JAMA, April 19, 2000; 283(15): 1967 - 1975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Chobanian and M. Hill National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure : A Critical Review of Current Scientific Evidence Hypertension, April 1, 2000; 35(4): 858 - 863. [Full Text] [PDF]
|
|
|
|
|
|
Y.-H. Liu, X.-P. Yang, D. Mehta, M. Bulagannawar, G. M. Scicli, and O. A. Carretero Role of kinins in chronic heart failure and in the therapeutic effect of ACE inhibitors in kininogen-deficient rats Am J Physiol Heart Circ Physiol, February 1, 2000; 278(2): H507 - H514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.A. van Zwieten The influence of antihypertensive drug treatment on the prevention and regression of left ventricular hypertrophy Cardiovasc Res, January 1, 2000; 45(1): 82 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Feldman, N. Campbell, P. Larochelle, P. Bolli, E. D. Burgess, S. G. Carruthers, J. S. Floras, R. B. Haynes, G. Honos, F. H.H. Leenen, et al. 1999 Canadian recommendations for the management of hypertension Can. Med. Assoc. J., December 14, 1999; 161(90120): S1 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D. Freis Improving Treatment Effectiveness in Hypertension Arch Intern Med, November 22, 1999; 159(21): 2517 - 2521. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Schirmer, P. Lunde, and K. Rasmussen Prevalence of left ventricular hypertrophy in a general population; The Tromso Study Eur. Heart J., March 2, 1999; 20(6): 429 - 438. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Thurmann, P. Kenedi, A. Schmidt, S. Harder, and N. Rietbrock Influence of the Angiotensin II Antagonist Valsartan on Left Ventricular Hypertrophy in Patients With Essential Hypertension Circulation, November 10, 1998; 98(19): 2037 - 2042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Chrysant Fixed Low-Dose Drug Combination for the Treatment of Hypertension Arch Fam Med, July 1, 1998; 7(4): 370 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. O. Ofili, J. D. Cohen, J. A. St. Vrain, A. Pearson, T. J. Martin, N. D. Uy, R. Castello, and A. J. Labovitz Effect of Treatment of Isolated Systolic Hypertension on Left Ventricular Mass JAMA, March 11, 1998; 279(10): 778 - 780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, G. Schillaci, C. Borgioni, A. Ciucci, R. Gattobigio, I. Zampi, G. Reboldi, and C. Porcellati Prognostic Significance of Serial Changes in Left Ventricular Mass in Essential Hypertension Circulation, January 13, 1998; 97(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Arch Intern Med, November 24, 1997; 157(21): 2413 - 2446. [Abstract] [PDF]
|
|
|
|
|
|
F. H. Messerli, R. E. Schmieder, and M. R. Weir Salt: A Perpetrator of Hypertensive Target Organ Disease? Arch Intern Med, November 24, 1997; 157(21): 2449 - 2452. [Abstract] [PDF]
|
|
|
|
|
|
R. B. Devereux Do Antihypertensive Drugs Differ in Their Ability to Regress Left Ventricular Hypertrophy? Circulation, April 15, 1997; 95(8): 1983 - 1985. [Full Text]
|
|
|
|
|
|
J. S. Gottdiener, D. J. Reda, B. M. Massie, B. J. Materson, D. W. Williams, and R. J. Anderson Effect of Single-Drug Therapy on Reduction of Left Ventricular Mass in Mild to Moderate Hypertension: Comparison of Six Antihypertensive Agents Circulation, April 15, 1997; 95(8): 2007 - 2014. [Abstract] [Full Text]
|
|
|
|
|
|
M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
|
|
|
|
|
|
T. Nishikimi, F. Yoshihara, A. Morimoto, K. Ishikawa, T. Ishimitsu, Y. Saito, K. Kangawa, H. Matsuo, T. Omae, and H. Matsuoka Relationship Between Left Ventricular Geometry and Natriuretic Peptide Levels in Essential Hypertension Hypertension, July 1, 1996; 28(1): 22 - 30. [Abstract] [Full Text]
|
|
|
|
|
|
R. B. Devereux Regression of Left Ventricular Hypertrophy: How and Why? JAMA, May 15, 1996; 275(19): 1517 - 1518. [Abstract] [PDF]
|
|
|
|
 |
|
 J. D. Corson, C. R. Mohan, J. J. Hoballah, W. J. Sharp, and T. F. Kresowik Atherosclerosis and Risk Factor Modification: Does It Really Make a Difference? Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1996; 9(1): 75 - 94. [PDF]
|
|