Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial.

Author(s): Terpstra WF, May JF, Smit AJ, de Graeff PA, Havinga TK, van den Veur E, Schuurman FH, Meyboom-de Jong B, Crijns HJ

Affiliation(s): Department of Cardiology, University Hospital Groningen, The Netherlands. w.f.terpstra@castel.nl

Publication date & source: 2001-02, J Hypertens., 19(2):303-9.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To compare the effects of a calcium antagonist (amlodipine) and an angiotensin converting enzyme inhibitor (lisinopril) on left ventricular mass and diastolic function in elderly, previously untreated hypertensives. DESIGN: A double-blind randomized parallel group trial. Effects of amlodipine and lisinopril on left ventricular mass and diastolic function (E/A Ratio) (The ELVERA trial). SETTING: Rural northern Netherlands: population screening new diagnosed hypertensive subjects. PATIENTS: The study population comprised 166 newly diagnosed hypertensive (aged 60-75) with diastolic blood pressure between 95-115 mmHg and/or systolic blood pressure between 160-220 mmHg. INTERVENTION: Patients were randomly allocated to receive 5-10 mg amlodipine or 10-20 mg lisinopril for 2 years. MAIN OUTCOME MEASURES: Prior and after 1 and 2 years of treatment left ventricular mass, indexed by body surface (LVMI) was estimated by 2-D mode echocardiography according to Devereux with use of Penn convention. Early to atrial filling ratio (E/A) was assessed by transmitral flow. Change from baseline of LVMI and E/A ratio was evaluated by repeated measurement analysis of the treatment effect in an intention-to-treat analysis. RESULTS: Both amlodipine and lisinopril led to equivalent reduction in systolic and diastolic blood pressure. At the end of the study the amlodipine group led to LVMI decrease by 21.8 g/m < or = [95% confidence interval (CI), 18.3-25.3] and E/A ratio increased by 0.08 (95% CI, 0.05-0.11). In the lisinopril group LVMI decreased by 22.4 g/m < or = (95%, CI, 19.0-25.8) and E/A ratio increased by 0.07 (95% CI, 0.04-0.10). No statistically significant differences were found in changes in LVMI and E/A ratio between amlodipine and lisinopril. CONCLUSION: A long-term study, the ELVERA trial proves that amlodipine and lisinopril reduce left ventricular mass and improve diastolic function to a similar extent in elderly newly diagnosed hypertensive patients.