Effects of antihypertensive treatment on ultrasound measures of myocardial fibrosis in hypertensive patients with left ventricular hypertrophy: results of a randomized trial comparing the angiotensin receptor antagonist, candesartan and the angiotensin-converting enzyme inhibitor, enalapril

Objective To compare the effects of the angiotensin II receptor antagonist candesartan with the angiotensin-converting enzyme inhibitor enalapril on myocardial fibrosis evaluated by echoreflectivity analysis. Methods Hypertensive patients (n=196) with echocardiographically documented left ventricular hypertrophy were randomized to candesartan 8-16 mg/day (n=91) or enalapril 10-20 mg/day (n=105) with possible addition of hydrochlorothiazide (12.5-25mg/day) for 48 weeks. Echoreflectivity analysis was performed on ultrasound two-dimensional tracings of the midapex septum with a specifically designed and validated software. Colour histograms were obtained; the primary outcome variable was the treatment-related change in histogram width (broadband), previously shown to correlate with collagen volume on endomyocardial biopsy; changes in mean colour scale were secondary outcome variable. Results Echoreflectivity analysis was feasible in 84 patients (48 candesartan, 36 enalapril). Broadband decreased significantly in the candesartan (-8.0 colour levels) and in the enalapril group (-12.9 colour levels) with no significant difference between treatments (P=0.409); no significant changes occurred in mean colour scale. Patients under monotherapy (n=46) showed similar trends as the larger intention to treat cohort, without significant difference between treatments. Conclusion In hypertensive patients with left ventricular hypertrophy, both candesartan and enalapril induce a moderate but statistically significant reduction in an echoreflectivity index of myocardial fibrosis. J Hypertens 27:626-632 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.