Three-Dimensional Echocardiographic and Magnetic Resonance Assessment of the Effect of Telmisartan Compared With Carvedilol on Left Ventricular Mass

The hypothesis that left ventricular hypertrophy regression in hypertension relates to blood pressure (BP) control and to non-antihypertensive activity of some drugs was tested by comparing the effects of telmisartan and carvedilol on 24-h mean ambulatory BP and left ventricular mass (LVM) regression, measured using three-dimensional echocardiography (3-DECHO) and magnetic resonance imaging (MRI). A total of 82 patients with mild-to-moderate hypertension and an optimal echocardiographic acoustic window were randomized to receive once-daily telmisartan 80 mg or carvedilol 25 mg for 44 weeks. Ten patients withdrew from the study because office diastolic BP remained >90 mm Hg. The 24-h mean ambulatory systolic/diastolic BP reductions were similar in both treatment groups (telmisartan, from 159.6 ± 10.2/97.8 ± 5.4 to 128.6 ± 6.5/78.2 ± 5.8 mm Hg; carvedilol, from 157.8 ± 11.1/95.7 ± 11.9 to 128.2 ± 5.6/78.7 ± 5.2 mm Hg). However, night-time and last 6-h mean BP reductions were nonsignificantly greater with telmisartan. Using 3-DE, telmisartan ( P< .001) and carvedilol ( P< .001) progressively reduced LVM index by 21.97 ± 5.84 (15.7%) and 12.31 ± 3.14 (9.1%) g/m 2, respectively, at week 44. Similar magnitudes of reductions were observed using MRI (15.5% and 9.6%, respectively). Reductions in LVM index achieved with telmisartan were statistically superior to carvedilol ( P≤ .001). The superior LVM regression with telmisartan versus carvedilol suggests telmisartan has a mechanism that may be beyond that of lowering BP in hypertensive patients.