Hydrochlorothiazide and alternative diuretics versus renin-angiotensin system inhibitors for the regression of left ventricular hypertrophy: a head-to-head meta-analysis

Journal of Hypertension
George C RoushDomenic A Sica

Abstract

Found in 36-41% of hypertension, elevated left ventricular mass (LVM) independently predicts cardiovascular events and total mortality. Conversely, drug-induced regression of LVM predicts improved outcomes. Previous studies have favored renin-angiotensin system inhibitors (RASIs) over other antihypertensives for reducing LVM but ignored differences among thiazide-type diuretics. From evidence regarding potency, cardiovascular events, and electrolytes, we hypothesized a priori that 'CHIP' diuretics [CHlorthalidone, Indapamide and Potassium-sparing Diuretic/hydrochlorothiazide (PSD/HCTZ)] would rival RASIs for reducing LVM. Systematic review yielded 12 relevant double-blind randomized trials. CHIPs were more closely associated with reduced LVM than HCTZ (P = 0.004), indicating that RASIs must be compared with each diuretic separately. Publication bias favoring RASIs was corrected by cumulative analysis. For reducing LVM, HCTZ tended to be less effective than RASIs. However, the following surpassed RASIs: chlorthalidone Hedge's G: -0.37 (95% CI -0.72 to -0.02), P = 0.036; indapamide -0.20 (-0.39 to -0.01), P = 0.035; all CHIPs combined (with 61% of patients in one trial) -0.25 (-0.41to -0.09), P = 0.002. Statistical significance (...Continue Reading

References

Mar 21, 1998·JAMA : the Journal of the American Medical Association·E O OfiliA J Labovitz
Apr 29, 1998·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·R E SchmiederP Martus
Oct 6, 1998·Journal of Human Hypertension·M A TedescoA Iacono
Jul 18, 2003·The American Journal of Medicine·Arnfried U KlingbeilRoland E Schmieder
Sep 7, 2004·Proceedings. Biological Sciences·Roosa Leimu, Julia Koricheva
Nov 18, 2004·JAMA : the Journal of the American Medical Association·Richard B DevereuxBjörn Dahlöf
Nov 18, 2004·JAMA : the Journal of the American Medical Association·Julius M Gardin, Michael S Lauer
Aug 27, 2005·Hypertension·Joseph I Shapiro
Apr 20, 2007·Current Hypertension Reports·Guilhem du Cailar, Albert Mimran
Aug 22, 2009·The Journal of Clinical Hypertension·Matthew R Weir, Raymond R Townsend
Apr 24, 2010·American Journal of Hypertension·Sante D Pierdomenico, Franco Cuccurullo
Jan 22, 2011·European Journal of Clinical Investigation·Yen-Hung LinUNKNOWN TAIPAI study group
Nov 25, 2011·Journal of Human Hypertension·C CuspidiUNKNOWN Italian Society of Hypertension

❮ Previous
Next ❯

Citations

Sep 27, 2018·The Journal of Clinical Hypertension·Marijana Tadic, Cesare Cuspidi
Mar 19, 2019·Journal of Hypertension·Michel BurnierBryan Williams
Sep 6, 2020·Current Hypertension Reports·Maximillian T Bourdillon, Ramachandran S Vasan
Oct 9, 2021·Journal of Cardiovascular Pharmacology and Therapeutics·David Mondaca-RuffJorge E Jalil
Oct 11, 2021·The Cochrane Database of Systematic Reviews·Leire LeacheKaduo J Arai

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antihypertensive Agents: Mechanisms of Action

Antihypertensive drugs are used to treat hypertension (high blood pressure) which aims to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Discover the latest research on antihypertensive drugs and their mechanism of action here.