Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril
Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril
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DOI：
10.1161/hc3901.096700
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发表时间：
2001-10-02
期刊：
影响因子：
37.8
通讯作者：
Yusuf, S
中科院分区：
文献类型：
--
作者：
Mathew, J;Sleight, P;Yusuf, S
左心室肥大（LVH）的心电图标志物预示预后不良。我们确定了ACE抑制剂雷米普利是否可以预防ECG-LVH的发展和消退，以及这些变化是否与独立于血压降低的预后改善有关。方法和结果在心脏预后预防评估（HOPE）研究中，高危患者被随机分配到雷米普利或安慰剂组，并随访4.5年。在基线和研究结束时记录ECG。我们比较了两组中ECG-LVH的预防/消退和发展/持续性，并将这些变化与结局相关。基线时，676例患者有LVH（雷米普利组321例，安慰剂组355例），7605例患者无LVH（雷米普利组3814例，安慰剂组3791例）。研究结束时，雷米普利组336例（8.1%）与安慰剂组406例（9.8%）发生/持续LVH;相比之下，雷米普利组3799例（91.9%）与安慰剂组3740例（90.2%）发生LVH消退/预防（P=0.007）。雷米普利对LVH的作用与血压变化无关。LVH消退/预防患者发生预定主要结局（心血管死亡、心肌梗死或卒中）的风险低于LVH发展/持续患者（12.3% vs 15.8%，P=0.006）和充血性心力衰竭患者（9.3% vs 15.4%，P
Background-Electrocardiographic markers of left ventricular hypertrophy (LVH) predict poor prognosis. We determined whether the ACE inhibitor ramipril prevents the development and causes regression of ECG-LVH and whether these changes are associated with improved prognosis independent of blood pressure reduction.Methods and Results-In the Heart Outcomes Prevention Evaluation (HOPE) study, patients at high risk were randomly assigned to ramipril or placebo and followed for 4.5years. ECGs were recorded at baseline and at study end. We compared prevention/regression and development/persistence of ECG-LVH in the two groups and related these changes to outcomes. At baseline, 676 patients had LVH (321 in the ramipril group and 355 in the placebo group) and 7605 patients did not have LVH (3814 in the ramipril group and 3791 in the placebo group). By study end, 336 patients in the ramipril group (8.1%) compared with 406 in the placebo group (9.8%) had development/persistence of LVH; in contrast, 3799 patients in the ramipril group (91.9%) compared with 3740 in the placebo group (90.2%) had regression/prevention of LVH (P=0.007). The effect of ramipril on LVH was independent of blood pressure changes. Patients who had regression/prevention of LVH had a lower risk of the predefined primary outcome (cardiovascular death, myocardial infarction, or stroke) compared with those who had development/persistence of LVH (12.3% versus 15.8%, P=0.006) and of congestive heart failure (9.3% versus 15.4%, P