Nephrology Dialysis Transplantation, Vol 12, Issue 5 945-951, Copyright © 1997 by Oxford University Press
A Dyadyk, A Bagriy, I Lebed, N Yarovaya, E Schukina and G Taradin
Background. Left ventricular hypertrophy is frequently
noted in patients with moderate to severe chronic renal failure not
requiring dialysis. Recently, several studies have shown reversal of
myocardial hypertrophy in end-stage renal disease with long-term
pharmacological control of blood pressure, but it is unclear whether left
ventricular mass regresses or normalizes with antihypertensive treatment of
patients with earlier stages of chronic renal failure.
Methods. Seventy-two undialysed patients with chronic
renal failure, chronic mild-to-moderate hypertension, and left ventricular
hypertrophy were randomly assigned in a prospective study to either the
captopril (n = 36) or enalapril group
(n = 36). Blood pressure measurements,
echocardiographic and Doppler parameters were evaluated before treatment
and at 6 and 12 months of therapy. Results. During
follow-up, six patients developed side-effects including dry cough, taste
disturbances, skin rash and gastric intolerance. In the captopril group
there was a decrease in mean left ventricular mass index by 12% after 6
months of treatment, which decreased by 20% after 12 months treatment. For
enalapril, the average reduction of myocardial mass after 6 months
treatment was 14% and after 12 months treatment, the decrease was 19%. In
both treatment groups there was significant improvement of left ventricular
filling dynamics. No deterioration of left ventricular systolic function
was observed. Conclusions. Our results confirm that
antihypertensive monotherapy with the ACE inhibitors, captopril and
enalapril, in patients with chronic renal failure results in regression of
left ventricular mass index associated with a significant improvement in
the diastolic function of the left ventricle without a demonstrable
deterioration in left ventricular systolic performance.
Keywords: ACE inhibition; blood pressure control;
chronic renal failure; diastolic function; left ventricular hypertrophy
ORIGINAL ARTICLES
ACE inhibitors captopril and enalapril induce regression of left ventricular hypertrophy in hypertensive patients with chronic renal failure
Department of Postgraduate Therapy Training, Medical University, Diagnostic Center, Donetsk, Ukraine; Correspondence to AI Dyadyk, Teatralniy prospect 24, 18, Donetsk, 340050, Ukraine
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