Effects of Spironolactone During an Angiotensin II Receptor Blocker Treatment on the Left Ventricular Mass Reduction in Hypertensive Patients With Concentric Left Ventricular Hypertrophy

• Published in: Circulation Journal 2006, Vol.70(8), pp.995-1000
• Main Authors: Taniguchi, Ikuo, Kawai, Makoto, Date, Taro, Yoshida, Satoru, Seki, Shingo, Taniguchi, Masayuki, Shimizu, Mitsuyuki, Mochizuki, Seibu
• Format: Article
• Language: English
• Subjects: Aged; Aldosterone - blood; Aldosterone - physiology; Angiotensin II - blood; Angiotensin II receptor blocker; Angiotensin II Type 1 Receptor Blockers - pharmacology; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Benzimidazoles - pharmacology; Benzimidazoles - therapeutic use; Blood Pressure - drug effects; Blood Pressure - physiology; Echocardiography; Female; Heart Ventricles - drug effects; Heart Ventricles - pathology; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - pathology; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - pathology; Left ventricular hypertrophy; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - pharmacology; Mineralocorticoid Receptor Antagonists - therapeutic use; Natriuretic Peptide, Brain - blood; Renin angiotensin aldosteroneosterone system; Spironolactone; Spironolactone - pharmacology; Spironolactone - therapeutic use; Tetrazoles - pharmacology; Tetrazoles - therapeutic use; Ventricular Remodeling - drug effects
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.70.995

Background Angiotensin II receptor blockers (ARB) are now commonly used to treat hypertension because of their beneficial effects on cardiovascular remodeling. However, ARB treatment can not inhibit the left ventricular (LV) remodeling sufficiently, which may be related with aldosterone secretion. To inhibit the action of aldosterone during ARB treatment, the additional effects of an aldosterone blocker and spironolactone (SPRL) on LV hypertrophy in patients with essential hypertension was studied. Methods and Results The patients with essential hypertension were randomly divided into 2 groups; 1 group was treated with an ARB, candesartan (8 mg/day), for 1 year (ARB group) and other group was treated with the ARB for the first 6 months and with the ARB plus SPRL (25 mg/day) for the next 6 months (combination group). Seventy patients who underwent echocardiography every 6 months were analyzed and were also classified into 4 subgroups of LV geometric pattern according to the LV mass index (LVMI) and the relative wall thickness (RWT). The ARB treatment and the addition of SPRL significantly reduced the blood pressure, however, both treatments did not affect the LV geometry in both groups. The ARB treatment in the subgroups of concentric LV remodeling (RWT ≥0.45 and LVMI