| Effects of eplerenone, enalapril, and eplerenone/enalapril in patients with essential hypertension and left ventricular hypertrophy: the 4E-left ventricular hypertrophy study. | |
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MedLine Citation:
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PMID: 14517164 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Elevated renin-angiotensin-aldosterone system activity correlates with left ventricular hypertrophy (LVH) and cardiovascular risk, but the relative contributions of angiotensin II and aldosterone remain unclear. This study compared LVH regression during treatment with the selective aldosterone blocker eplerenone, enalapril, and their combination in patients with hypertension. METHODS AND RESULTS: A 9-month, double-blind, randomized study was performed in 202 patients with LVH and hypertension who received eplerenone 200 mg daily, enalapril 40 mg daily, or eplerenone 200 mg and enalapril 10 mg daily. At week 8, hydrochlorothiazide 12.5 to 25 mg and/or amlodipine 10 mg was added if diastolic blood pressure was >90 mm Hg. Change in left ventricular (LV) mass as assessed by MRI was the primary end point. Change in blood pressure, renin-angiotensin-aldosterone system hormones, albuminuria, and safety were also assessed. Eplerenone significantly reduced LV mass from baseline (-14.5+/-3.36 g; n=50) similarly to enalapril (-19.7+/-3.20 g; n=54; P=0.258), but eplerenone/enalapril (-27.2+/-3.39 g; n=49) was more effective than eplerenone alone (P=0.007). All treatments reduced systolic blood pressure and diastolic blood pressure from baseline (eplerenone, -23.8 and -11.9 mm Hg; enalapril, -24.7 and -13.4 mm Hg; and eplerenone/enalapril, -28.7 and -14.4 mm Hg, P=0.048, in systolic blood pressure compared with eplerenone alone). Cough was more common with enalapril than with eplerenone (P=0.033), and elevated potassium was more common with eplerenone. CONCLUSIONS: Eplerenone was as effective as enalapril in LVH regression and blood pressure control. The combination of eplerenone and enalapril was more effective in reducing LV mass and systolic blood pressure than eplerenone alone. |
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Authors:
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Bertram Pitt; Nathaniel Reichek; Roland Willenbrock; Faiez Zannad; Robert A Phillips; Barbara Roniker; Jay Kleiman; Scott Krause; Daniel Burns; Gordon H Williams |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2003-09-29 |
Journal Detail:
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Title: Circulation Volume: 108 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Oct |
Date Detail:
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Created Date: 2003-10-14 Completed Date: 2003-11-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1831-8 Citation Subset: AIM; IM |
Affiliation:
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University of Michigan Health System, Ann Arbor, Mich, USA. bpitt@umich.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aldosterone Antagonists / administration & dosage, therapeutic use* Amlodipine / administration & dosage, therapeutic use Angiotensin-Converting Enzyme Inhibitors / administration & dosage, therapeutic use* Antihypertensive Agents / administration & dosage, therapeutic use* Double-Blind Method Drug Synergism Drug Therapy, Combination Enalapril / administration & dosage, therapeutic use* Female Humans Hydrochlorothiazide / administration & dosage, therapeutic use Hypertension / drug therapy*, physiopathology Hypertrophy, Left Ventricular / drug therapy*, physiopathology Magnetic Resonance Imaging Male Middle Aged Myocardium / pathology Potassium / blood Renin-Angiotensin System / drug effects*, physiology Spironolactone / administration & dosage, analogs & derivatives*, therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Aldosterone Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/eplerenone; 52-01-7/Spironolactone; 58-93-5/Hydrochlorothiazide; 7440-09-7/Potassium; 75847-73-3/Enalapril; 88150-42-9/Amlodipine |
| Comments/Corrections | |
Comment In:
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Circulation. 2003 Oct 14;108(15):e9042-3
[PMID:
14557352
]
Curr Hypertens Rep. 2004 Apr;6(2):113-4 [PMID: 15010013 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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