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A ray of light on Cardiology

The angiotensin-converting enzyme (ACE) inhibitor ramipril, used for the treatment of hypertension, can retrieve, and may even prevent, left ventricular hypertrophy (LVH), thereby lowering the risk of stroke and myocardial infarction (MI), a new study has shown.Results from the landmark Heat Outcome Prevention Evaluation (HOPE) study showed the drug to cause reversal and prevention of LVH in a broad range of patients – those with normal or controlled blood pressure, both with and without coronary heart disease.//

The HOPE study compared the effects of the ACE inhibitor in addition to standard therapy with placebo and vitamin E in a sample of about 7,580 high-risk patients with cardiovascular disease.In the HOPE sub-study, conducted by Dr James Chadwik and colleagues from the University of Baltimore, the electrocardiograms of 6,222 patients at baseline and at the end of the 4.5 year-long study were compared for the presence, regression or development of LVH. Cardiovascular outcomes such as MI, stroke and heart failure were also evaluated.

Among 92.9 per cent of the patients, ramipril either prevented or caused gradual regression of LVH, independent of its effect on blood pressure control. Adverse cardiovascular outcomes were also lower among those who did not develop LVH or experienced regression of their LVH, compared with those in which LVH developed or did not regress. However, 91 per cent of the patients who received a placebo experienced prevention or regression of LVH, which the researchers said was “intriguing” but was more likely to be due to other risk factor modifications among the study participants.

Since the regression of LVH found with the drug was independent of blood pressure reduction, the study authors suspect that ACE inhibitors have a direct effect in causing regression.Dr Gregory Bosen, professor of cardiovascular medicine at City Hospital in England, agrees that the research raises important issues. Dr Chadw ik said that monitoring changes in LVH status by ECG might predict outcomes for patients with the condition. “We think we can now reduce the risk of cardiovascular events and death by regression of LVH using ECG markers. The ECG is easily applied and relatively inexpensive.”

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