¹Department of Internal Medicine, University of Palermo, Palermo, ltaly

Correspondence: Professor R Scaglione, Department of internal Medicine, University of Palermo, Piazza della Cliniche 2, Via Lombardia n. 9, 90144 Palermo, Italy. E-mail: rosarioscaglione@yahoo.it

Received 7 July 2006; Revised 2 November 2006; Accepted 14 November 2006; Published online 15 February 2007.

Abstract

The effects of 24 weeks losartan and ramipril treatment, both alone and in combination, on left ventricular mass (LVM), circulating transforming growth factor 1 (TGF1), procollagen type I (PIP) and III (PIIIP), have been evaluated in hypertensive (HT) patients. A total of 57 HT with stage 1 and 2 essential hypertension were included. After 4 weeks run in, a randomized double-blind, three arms, double dummy, independent trial was used. All HT patients were randomly allocated to three treatment arms consisting of losartan (50 mg/daily), ramipril (5 mg/ daily) and combined (losartan 50 mg/daily + ramipril 5 mg/daily) for 24 weeks. TGF1, PIP and PIIIP, LVM, LVM/h^2.7 and other echocardiographic measurements, blood urea nitrogen, creatinine and clearance and potassium were determined after run in and after 24 weeks. All groups were comparable for gender, age, body mass index, blood pressure and LVM. The prevalence of baseline left ventricular hypertrophy (LVH) was not significantly different among three groups. At the end of treatment, a significant (P<0.05) reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), TGF1, PIP, PIIIP, LVM and LVM/h^2.7 was observed in all groups. The absolute and percent reduction in TGF1 and LVM/h^2.7 were significantly higher in combined than losartan or ramipril groups and also in HT patients with LVH. No significant change in absolute and percent reduction of SBP, DBP and MBP were found. Our data indicate an additional cardioprotective effect of dual blockade of renin–angiotensin in HT patients.