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Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension

Journal of Human Hypertension volume 20, pages 599–611 (2006)Cite this article

Abstract

We investigated the effects of aggressive antihypertensive therapy based on hydrochlorothiazide, candesartan or lisinopril on left ventricular mass (LVM) index and arterial stiffness in hypertensive type II diabetic individuals. Seventy hypertensive type II diabetic individuals were treated with three antihypertensive strategies in a randomized, double-blind, double-dummy design. Blood pressure was titrated to levels below 130/85 mm Hg or a decrease in systolic pressure of 10% with a diastolic pressure below 85 mm Hg. After titration, patients were treated for 12 months. Mean blood pressures were 157/93, 151/94 and 149/93 mm Hg at baseline in the hydrochlorothiazide (n=24), candesartan (n=24) and lisinopril (n=22) groups, and 135/80, 135/82 and 131/80 mm Hg after titration. About 70% reached target blood pressures, with the median use of three antihypertensive drugs. Left ventricular mass index and all estimates of arterial stiffness showed significant improvement after 12 months: that is, LVM index (−11 g/m2; −8%); carotid distensibility coefficient (DC; +2.8 × 10−3 kPa−1; +27%), compliance coefficient (CC; +0.13 mm2/kPa; +21%) and elastic modulus (−0.19 kPa; −16%); femoral DC (+1.6 × 10−3 kPa−1; +50%) and CC (+0.08 mm2/kPa; +26%); brachial DC (+2.1 × 10−3 kPa−1; +39%) and CC (+0.03 mm2/kPa; +27%) and total systemic arterial compliance (+0.29 ml/mm Hg; +16%). No differences in outcome variables between treatment groups were observed. Aggressive antihypertensive treatment, although difficult to achieve, resulted in substantial reductions of LVM index and arterial stiffness in relatively uncomplicated hypertensive type II diabetic individuals. Strategies based on renin–angiotensin system inhibitors were not clearly superior to conventional (i.e. diuretic-based) strategies.

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Acknowledgements

AstraZeneca provided funding for this clinical trial (to CDA Stehouwer), but had no influence on the data analyses or manuscript preparation. We thank Ellen Bulterijs, Greetje de Vries and Harry Twaalfhoven for their excellent assistance.

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Authors and Affiliations

  1. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands

    A M E Spoelstra-de Man, F J van Ittersum, M T Schram, O Kamp, R A J M van Dijk, R G IJzerman, J W R Twisk & C D A Stehouwer

  2. Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

    A M E Spoelstra-de Man, M T Schram & R G IJzerman

  3. Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands

    F J van Ittersum

  4. Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands

    O Kamp

  5. Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands

    R A J M van Dijk

  6. Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands

    J W R Twisk

  7. Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    C B Brouwer

  8. Department of Internal Medicine, Academic Hospital Maastricht, Maastricht, The Netherlands

    C D A Stehouwer

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  1. A M E Spoelstra-de Man
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Spoelstra-de Man, A., van Ittersum, F., Schram, M. et al. Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension. J Hum Hypertens 20, 599–611 (2006). https://doi.org/10.1038/sj.jhh.1002025

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