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Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in hypertensive patients with diabetes: data from the SARA study

Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain, vbarriosa{at}meditex.es

Carlos Escobar

Department of Cardiology, Hospital Infanta Sofia, Madrid, Spain

Alberto Calderón

Primary Health Care Centre Rosa de Luxemburgo, Madrid, Spain

Rocio Echarri

Department of Nephrology, Hospital Infanta Sofia, Madrid, Spain

Sara Barrios

Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain

Josefa Navarro-Cid

Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain

Introduction. This study examined the influence of diabetes on left ventricular hypertrophy (LVH) detected by different electrocardiographic (ECG) criteria and its changes induced by a 12-month candesartan-based regimen.

Methods. The patients were treated for a 12-month period with a candesartan-based regimen (8/16 mg + hydrochlorothiazide12.5 mg + additional drugs to target blood pressure < 140/90 mmHg [< 130/80 in diabetics]). Cornell voltage index (CorV), Cornell product (CorP), Sokolow-Lyon voltage index (SokV), and Sokolow-Lyon product (SokP) were calculated. In total 276 patients were included, 51 with diabetes.

Results. At study end, blood pressure was reduced 19.0±9.2/7.3±3.4 mmHg in diabetic patients and 18.8±9.1/8.0±3.2 mmHg in non-diabetic subjects (both p<0.01 vs. baseline; p=0.85 between groups).At baseline, 37.5% of diabetic and 26.4% of non-diabetic patients fulfilled criteria of ECG-LVH by CorP (p=0.02), 25.7% and 23.2%, respectively, by SokP (p=0.18), 11.8% and 13.7% by CorV (p=0.16), and 14.3% and 11.6% by SokV (p=0.10).At study end, the prevalence of ECG-LVH was reduced to 25.1% (relative risk reduction [RRR] 33.3%, p=0.001) and 18.2% (RRR 29.2%, p=0.001) by CorP and SokP, in diabetic patients, respectively. In non-diabetic patients, only the CorP criterion showed a significant decrease (RRR 18.9%, p=0.01). No significant changes were observed by other criteria.The RRR of ECG-LVH with treatment was significantly higher in diabetics according to CorP and SokP criteria.

Conclusions. The prevalence of ECG-LVH detected by CorP was higher in diabetics. Diabetics achieved higher reductions in ECG-LVH prevalence than non-diabetics with a candesartan-based regimen.

Key Words: candesartan • diabetes • electrocardiogram • left ventricular hypertrophy • regression

This version was published on September 1, 2009

Journal of Renin-Angiotensin-Aldosterone System, Vol. 10, No. 3, 168-173 (2009)
DOI: 10.1177/1470320309343596


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