Abstract 16540: Blockade of the Renin-Angiotensin System is More Effective in Reducing Blood Pressure Hypertensive Patients With Left Ventricular Hypertrophy: Results From the 3A Registry
Background Left ventricular hypertrophy (LVH) is common in hypertensive (HTN) patients, and it increases the risk of myocardial infarction, stroke, and death has been numbered in hypertensive patients to 20% and above within 10 years. Recent evidence indicates it is a modifiable risk factor that is not entirely dependent on blood pressure (BP) control. Furthermore little prospective data are available about BP control in these high risk HTN patients with the direct renin inhibitor aliskiren (AL) in daily practice.
Methods - In the non-interventional 3A Registry study conducted in Germany since 3 years, patients were eligible for documentation in whom the physician had decided to modify the HTN therapy. This included treatment with the AL or an ACE-I/ARB or an agent not blocking the renin-angiotensin-system (RAS), alone or on top of an existing drug regimen. Patients were prospectively followed for one year. Here we report the results of the prespecified subgroup with patients with LVH disease.
Results: Of the 14988 patients recruited by 899 physicians in Germany in 2008 and 09, an ECG was performed in 8820 patients (59%) only. Electrocardiographic signs of LVH were present in 1729 patients (19%). Cardiovascular (CV) disease was present in 869 (50.9%) Diabetes mellitus in 651 (37.7%) and chronic kidney disease (GFR < 60 mL/min/1.73 m) in 455 (26.5%) patients with LVH. The treating physicians performed the following diagnostic procedures in the patient group with LVH: Serum creatinine was measured in 99.5%, Cholesterol in 79.7% and Glucose in 78.8 % of the patients, whereas proteinuria was performed in 13.9% and 24h R APBDM in 57.3%. Absolute BP reduction was 20.2±22.0/10.0±12.5 for the AL-, 20.1±21.4/10.4±12.7 for ACE-I/ARB- and 16.5±19.3 /9.5±12.4 mg for the non-RAS base regime (p=0.34/ p=0.86).
Conclusion: In this large real life registry of HTN outpatients with LVH blocking the RAS showed better BP reductions compared to treatment without blocking the RAS. A significant proportion of the patients with HTN did not receive all necessary optimal diagnostics according to the guidelines, so that the presence of LVH is underreported.
- © 2011 by American Heart Association, Inc.