Agabiti-Rosei E, Ambrosioni E, Dal Palù C, Muiesan M L, Zanchetti A
Semeiotica and Metodologia Medica, University of Brescia, Italy.
J Hypertens. 1995 Nov;13(11):1325-34. doi: 10.1097/00004872-199511000-00015.
To compare the effect of the angiotensin converting enzyme (ACE) inhibitor ramipril with that of the beta-blocker atenolol on reversal of left ventricular hypertrophy, on blood pressure and on other echocardiographic parameters.
The study was conducted in accord with the PROBE (prospective randomized open blinded endpoint) design. Randomized treatment either with ramipril or with atenolol was continued for 6 months, and echocardiograms were recorded before and after 3 and 6 months of treatment. The echo tracings were blindly evaluated in a single reading centre.
M-mode, two-dimensional guided echocardiography was used to measure left ventricular wall thicknesses and dimensions, from which left ventricular mass was calculated, according to the Penn convention.
Of 193 patients at 16 centres, 111 had echocardiograms that could be quantitatively evaluated. The primary analysis of the study was performed using data from those patients. In addition, echocardiograms of 88 patients were analysed on an 'according to protocol' basis (patients with preset values of left ventricular mass). Systolic and diastolic blood pressures were significantly reduced both by ramipril and by atenolol without any significant difference between the two drug treatments. The heart rate was significantly reduced by atenolol only. Both the 'primary' and the 'according to protocol' analyses showed that the left ventricular mass was significantly reduced by ramipril only. Comparison between treatments according to a multivariate analysis demonstrated a significantly greater reduction in left ventricular mass during ramipril than during atenolol treatment.
The present study is the first of suitably large size in which a direct comparison of the effects of an ACE inhibitor and a beta-blocker on echocardiographic left ventricular mass has been performed. It has demonstrated that ramipril is more effective than atenolol in reversing left ventricular hypertrophy in essential hypertensive patients.
比较血管紧张素转换酶（ACE）抑制剂雷米普利与β受体阻滞剂阿替洛尔对左心室肥厚逆转、血压及其他超声心动图参数的影响。
本研究采用PROBE（前瞻性随机开放盲终点）设计。雷米普利或阿替洛尔随机治疗持续6个月，在治疗3个月和6个月前后记录超声心动图。超声心动图记录在单一阅读中心进行盲法评估。
采用M型、二维引导超声心动图测量左心室壁厚度和内径，根据Penn惯例计算左心室质量。
16个中心的193例患者中，111例患者的超声心动图可进行定量评估。本研究的主要分析使用这些患者的数据。此外，对88例患者的超声心动图进行了“按方案”分析（左心室质量预设值的患者）。雷米普利和阿替洛尔均显著降低收缩压和舒张压，两种药物治疗之间无显著差异。仅阿替洛尔显著降低心率。“主要”分析和“按方案”分析均显示，仅雷米普利显著降低左心室质量。多变量分析显示，与阿替洛尔治疗相比，雷米普利治疗期间左心室质量的降低更为显著。
本研究是首次对ACE抑制剂和β受体阻滞剂对超声心动图左心室质量的影响进行直接比较的适当大样本研究。结果表明，在原发性高血压患者中，雷米普利在逆转左心室肥厚方面比阿替洛尔更有效。
