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Change in blood pressure predicts regression of cardiac hypertrophy in patients of African ancestry receiving agents influencing the renin–angiotensin system

Journal of Human Hypertension volume 19, pages 659–661 (2005)Cite this article

Recent evidence suggests that regression of left ventricular hypertrophy (LVH) following the use of angiotensin II (AII) receptor antagonists is to some extent independent of blood pressure (BP) changes.1, 2, 3 These studies1, 2, 3 raise the question of whether changes in BP, when treating hypertension and utilizing agents that inhibit the renin–angiotensin system (RAS) are indeed an appropriate clinical index of modifications in target organ damage. Although alterations in BP appear to be a useful clinical index in patients of European ancestry,4 whether this effect is noted in populations of African ancestry whose BP responses to blockers of the RAS are quite distinct from other groups,5 is uncertain. Indeed, previous data from our group suggest that the use of angiotensin-converting enzyme inhibitors (ACEI) result in reductions in LV mass (LVM) in hypertensives of African ancestry in association with little change in BP.6 We were therefore concerned that the effects of reductions in BP on regression of LVM index (LVMI) may be eradicated by the reduction in LVMI, which is associated with minimal change in BP in response to ACEI. The question of whether decreases in BP predict regression of LVH is of particular importance in hypertensive groups of African ancestry who have higher LVH7 and in whom electrocardiograph criteria are poor indicators of LVH,8 thus necessitating the use of other clinical indicators of regression of LVH. Hence, the aim of our study was to determine whether in hypertensive subjects of African ancestry, change in BP can predict changes in LVMI in response to combination therapy including RAS blockers.

To address this issue, in a single centre, prospective, open-label study, we assessed the relationship between changes in BP and alterations in LVM following the use of agents that target the RAS used together with a diuretic agent, in hypertensives of African ancestry with LVH. Both an AII receptor blocker and an ACEI were studied as a degree of synergy exists in this combination.9

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Acknowledgements

This study was supported by an educational grant from AstraZeneca Laboratories, South Africa.

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Authors and Affiliations

  1. Department of Cardiology, Chris Hani-Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa

    E N Libhaber, C D Libhaber, G P Candy, K Sliwa, M R Essop & P Sareli

  2. Department of Physiology, Chris Hani-Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa

    G R Norton & A J Woodiwiss

  3. Department of Surgery, Chris Hani-Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa

    G P Candy

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  1. E N Libhaber
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  2. G R Norton
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  7. M R Essop
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  8. P Sareli
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Libhaber, E., Norton, G., Libhaber, C. et al. Change in blood pressure predicts regression of cardiac hypertrophy in patients of African ancestry receiving agents influencing the renin–angiotensin system. J Hum Hypertens 19, 659–661 (2005). https://doi.org/10.1038/sj.jhh.1001879

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