Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996)

Nephrol Dial Transplant. 1998 Mar;13(3):564-9. doi: 10.1093/ndt/13.3.564.


Objective: To provide an update on the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension.

Data sources: Relevant medical databases including MEDLINE, BIOSIS PREVIEWS, EMBASE, and SCISEARCH as well as review articles to December 1996.

Study selection: Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design.

Data extraction: Literature search and data extraction according to a prefixed scheme performed independently by two investigators. The primary parameter was reduction of left ventricular mass by antihypertensive therapy with placebo, diuretics, beta-blockers, calcium channel blockers, or ACE-inhibitors.

Data synthesis: Fifty studies published till the end of December 1996 were identified. They comprised a total of 1715 patients in 13 placebo (n=165, age: 50+/-3 years) and 89 active treatment arms (n=1550, age: 56+/-10 years) respectively. Overall, for active treatment left ventricular mass index was the more reduced the greater the decrease in systolic blood pressure, (r=0.27; P<0.05), the longer the duration of therapy (r=0.36; P<0.001), and the higher the pretreatment value of left ventricular mass index (r= 0.53; P<0.001). Left ventricular mass index was decreased by 12% with ACE-inhibitors (95% CI: 9.0-14.5%), by 11% with calcium channel blockers (95% CI: 7.8-13.7%), by 5% with beta-blockers (95% CI: 1.2-7.3%) and by 8% with diuretics (95% CI: 3.9-11.1%) (overall P<0.01). Subsequent tests revealed that ACE-inhibitors and calcium channel blockers were more effective than beta-blockers in reducing left ventricular mass index (P<0.05). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<0.05).

Conclusions: Decrease in systolic blood pressure, duration of antihypertensive therapy, degree of pretreatment left ventricular hypertrophy and antihypertensive drug class determined the reduction of left ventricular hypertrophy. ACE-inhibitors and calcium channel blockers were more potent in reducing left ventricular mass than beta-blockers, with diuretics in the intermediate range.

Publication types

  • Clinical Trial
  • Meta-Analysis
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use*
  • Calcium Channel Blockers / therapeutic use
  • Databases, Factual
  • Diuretics / therapeutic use
  • Double-Blind Method
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Hypertrophy, Left Ventricular / drug therapy*
  • Hypertrophy, Left Ventricular / etiology
  • Middle Aged


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Diuretics