Electrocardiographic left ventricular hypertrophy regression induced by an angiotensin receptor blocker-based regimen in daily clinical practice: the SARA study

Aim Clinical trials have proved that angiotensin receptor blockers (ARB) are more effective than other antihypertensive agents in reducing left ventricular hypertrophy (LVH); however, information about the efficacy of ARB on LVH regression in daily medical practice is scarce. The aim of the SARA study was to investigate the effect of an ARB on electrocardiographic LVH (ECG-LVH) in a hypertensive outpatient population attending clinical practice. Methods From 276 recruited patients with mild-to-moderate essential hypertension (245 uncontrolled, 31 newly diagnosed), 264 (age: 62.9 +/- 11.6 years; 51.2% women) completed the study and were valid for the analysis. The patients were treated for a 12-month period with a candesartan-based regimen [(8/ 16 mg + hydrochlorothiazide 12.5 mg + additional drugs to target BP<140/90 mmHg (<130/80 in diabetics)]. ECG changes were measured at a core laboratory and Cornell product (Corp), Sokolow-Lyon product (SokP) and QRS duration (QRSd) criteria were determined. Results At baseline, 27.4% of patients fulfilled the criteria of LVH by Corp. The proportion of patients with ECG-LVH by Corp criteria decreased to 21.1% at the end of the study, relative risk reduction (RRR) was 22.9%, P<0.001. When using SokP the percentage of ECG-LVH reduced from 24.1 to 21.7% (RRR 9.6%, P = 0.1). Quantitatively, Corp was reduced by 84.4 mm x ms [95% confidence interval (CO: -8.14, -160.66; P= 0.03]; a greater reduction was detected in obese patients (P<0.05), diabetics (P<0.07) and patients with baseline ECG-LVH (P<0.05). In the multivariate analysis, female gender, baseline systolic blood pressure, baseline Corp and QRSd values were the main predictive factors for ECG-LVH regression. Conclusion The SARA study demonstrates that a candesartan-based regimen reduces ECG-LVH in the hypertensive population attending daily in clinical practice.