Comparison between nebivolol and ramipril in patients with hypertension and left ventricular hypertrophy: a randomized open blinded end-point (PROBE) trial

N. Çaglar, I. Dincer

Ibn Sina Hospital, School of Medicine, University of Ankara, Ankara (Turkey)

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• Cardiology

Aims: To compare the effects of nebivolol and ramipril on left ventricular hypertrophy in hypertensive patients.

Materials and Methods: The study was conducted with a pre-randomised blinded endpoint (PROBE) design in which 106 patients with mild-to-moderate hypertension and left ventricular hypertrophy were randomised to ramipril (n=52) or to nebivolol (n=54) and treated for 39 weeks. The doses of ramipril and nebivolol were 2.5 and 5 mg/day, respectively. After 4-8 weeks, in patients with not normalised diastolic blood pressure, a thiazide diuretic was added (indapamide 2.5 mg or hydrochlorothiazide 12.5 mg/day). In the ramipril group, thiazide diuretic was added in 97% of subjects and in nebivolol group in 92%. The effect of treatment on left ventricular mass was assessed by two-dimensional guided M-mode transthoracic echocardiography, at baseline and at the end of the treatment. Left ventricular mass index (LVMI) was calculated and indexed to body surface area (g/m2) and height2.7 (g/height2.7). Blood pressure (BP) was measured at baseline, after 4, 8, 12, 24 and 39 weeks with a standard mercury sphygmomanometer.

Results: Both left ventricular mass (LVM) and mass index (LVMI) decreased significantly after treatment with ramipril (LVMI – 14.8 g/m2, –7.3 g/height2.7; p < 0.001), and after treatment with nebivolol (LVMI –31.9 g/m2, –15.6 g/height2.7; p < 0.001). The difference between ramipril and nebivolol (–17.1 g/m2, –8.3 g/height2.7) with regards to reduction of LVMI was statistically significant (p < 0.001). No differences were observed between the two groups in terms of normalization of LVMI. Both drugs decreased BP similarly after 39 weeks of treatment.

Conclusions: The present study shows that both nebivolol and ramipril decrease LVMI. Nebivolol 5 mg/daily treatment reduced LVMI significantly more than ramipril 2.5 mg/daily. Both drugs similarly decreased BP during the treatment.

Corresponding Author: Nail Caglar, MD; e-mail: nailcaglar@gmail.com

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