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Suppression of aldosterone mediates regression of left ventricular hypertrophy in patients with hypertension

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Pouleur, Anne-Catherine [UCL] Uno, H. Prescott, M. F. Desai, A. Appelbaum, E. Solomon, S. D.

BACKGROUND: High circulating aldosterone levels stimulate myocardial fibrosis and left ventricular hypertrophy (LVH). However, it is not clear whether suppression of aldosterone directly contributes to LVH regression in hypertensive patients. METHODS: The Aliskiren in Left Ventricular Hypertrophy (ALLAY) trial randomised 465 hypertensive overweight subjects with LVH to the direct renin inhibitor aliskiren 300 mg, losartan 100 mg or the combination and followed patients for 9 months. All patients were treated to standard blood pressure targets. Left ventricular (LV) mass index (LVMI) and LV wall thickness (LVWT) were assessed by cardiac magnetic resonance. A subset of 136 patients who had plasma aldosterone concentration (ALDO) measured at baseline and study end was analysed. RESULTS: At baseline, plasma ALDO was modestly related to systolic blood pressure, LVMI, and wall thickness (all, p < 0.05). Aliskiren, either alone or in combination, was associated with a significantly greater reduction from baseline to 9 months in plasma aldosterone than losartan alone (p < 0.02). Reduction in ALDO was related to reduction in LVMI even after adjustment for baseline ALDO, BP reduction and treatment group (p for trend = 0.042). CONCLUSION: In hypertensive patients with increased LVWT, aliskiren alone or in combination with the angiotensin receptor blocker losartan provides greater reduction in aldosterone compared to losartan alone. Moreover, suppression of aldosterone was associated with reduction of LVH, independently of the change in SBP, suggesting that suppression of aldosterone, a known mediator of LVH, may be particularly important for LVH regression and as a target for therapy.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2011
Language Anglais
Journal information "Journal of the Renin-Angiotensin-Aldosterone System" - Vol. 12, no. 4, p. 483-490 (2011)
Peer reviewed yes
Publisher Sage Publications Ltd. ((United Kingdom) London)
issn 1470-3203
e-issn 1752-8976
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - (SLuc) Service de cardiologie
Keywords LV hypertrophy ; Aldosterone
Links
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Bibliographic reference Pouleur, Anne-Catherine ; Uno, H. ; Prescott, M. F. ; Desai, A. ; Appelbaum, E. ; et. al. Suppression of aldosterone mediates regression of left ventricular hypertrophy in patients with hypertension. In: Journal of the Renin-Angiotensin-Aldosterone System, Vol. 12, no. 4, p. 483-490 (2011)
Permanent URL http://hdl.handle.net/2078.1/122431