Abstract 4886: Change in Plasma Aldosterone Concentration is Important Determinant of Regression of LV Hypertrophy Following Anti-Hypertensive Medication
Introduction: Aldosterone is well known to bring about damages to various organs such as heart and kidney. However, it is unclear how important the changes in plasma aldosterone concentration (PAC) following long-term treatment with calcium-channel blockers (CCB) or Angiotensin II receptor blockers (ARB) as contributors to regression of LV hypertrophy in hypertensive patients. Thus, we studied effects of long-term CCB or ARB administration on PAC and the impact of the changes in PAC on LV geometry.
Methods: A total of 44 untreated hypertensive patients were enrolled. There were 31 males and 13 females with mean age of 57 years. They were randomly assigned to either CCB group in which Amlodipine of 5 to 10mg was given daily (n=22, 16 males and 6 females, mean age 57), or ARB group in which Losartan of 50 to 100mg was given daily (n=22, 15 males and 7 females, mean age 58). If blood pressure reduction was not achieved, alfa blocker and/or diuretics were added. LV geometry and function was echocardiographically assessed with LV mass index (LVMI) and relative wall thickness (RWT) before and 6 and 12 months after treatment along with PAC measurements.
There was no difference in systolic blood pressure (SBP) at any time between the CCB and ARB groups.
Mean SBP dropped from 160±3 to 138±3 mmHg at 12 months after treatment. PAC was not different before treatment between the groups, and did not change in 6 months in either group. PAC decreased in 12 months more in the ARB group than in the CCB group (−32±7 vs 17±13%, p<0.05 as %-reduction from the values before treatment).
Larger %-drop in PAC was associated with larger %-reduction of LVMI (r=0.40, p<0.05 for the CCB group; r=0.56, p<0.01 for the ARB group; r =0.45, p<0.01 for all).
Multiple step-wise regression analysis showed that the %-reduction of LVMI is related to the %-changes in SBP and the %-changes in PAC (r=0.46, p<0.01) but the selected medication, i.e., CCB or ARB, was not a significant contributor.
Conclusions: Regression of LV hypertrophy was larger in patients with a greater decrease in PAC associated with anti-hypertensive medication regardless of CCB or ARB. Changes in PAC and SBP are key determinants of regression of LV hypertrophy in hypertensive patients regardless of the medication selected.