PREVENTING LEFT VENTRICULAR HYPERTROPHY BY ACE INHIBITION IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A PRESPECIFIED ANALYSIS OF THE BENEDICT TRIAL

Abstract

Objective In patients with type 2 diabetes left ventricular hypertrophy (LVH) predicts cardiovascular events and its prevention is cardioprotective.

Research Design and Methods This pre-specified study compared the incidence of electrocardiographic (ECG) LVH by Sokolow-Lyon and Cornell voltage criteria in 816 hypertensive type 2 diabetic patients of the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) randomized to at least 3-year blinded angiotensin-converting-enzyme (ACE) inhibition with trandolapril (2 mg/day) or non-ACE inhibitor therapy, who had no ECG-LVH at baseline. Treatment was titrated to systolic/diastolic blood pressure (BP) <130/80 mmHg. ECG readings were centralized and blinded to treatment.

Results Baseline characteristics of the two groups were similar. Over a median (interquartile range) follow-up of 36 (24 to 48) months, 13 of the 423 patients (3.1%) on trandolapril compared to 31 of the 376 (8.2%) on non-ACE inhibitor therapy developed ECG-LVH. [Hazard Ratio (95% CI): 0.34 (0.18 to 0.65), P=0.0012 (unadjusted); 0.35 (0.18 to 0.68), P=0.0018 (adjusted for pre-define baseline covariates)]. The Hazard Ratio was significant even after adjustment for follow-up BP and BP reduction vs baseline. Compared to baseline, both Sokolow-Lyon and Cornell voltages significantly decreased on trandolapril, but did not change on non-ACE inhibitor therapy.

Conclusions ACE inhibition has a specific protective effect against the development of ECG-LVH that is additional to that of BP lowering. Since ECG-LVH is a strong cardiovascular risk factor in people with hypertension and diabetes, early ACE inhibition may be cardioprotective in this population.