Abstract 14102: Hydrochlorothiazide and Alternative Diuretics versus Renin-Angiotensin System Inhibitors for the Regression of Left Ventricular Hypertrophy: A Head-to-Head Meta-Analysis

Found in 36%-41% of hypertensive patients, left ventricular hypertrophy (LVH) independently predicts cardiovascular events and total mortality. Conversely, drug-induced LVH regression predicts improved outcomes. Previous meta-analytic, clinical, and laboratory studies have favored renin-angiotensin system inhibitors (RASIs) over other antihypertensives for reducing LVH, but have ignored differences among thiazide-type diuretics. Evidence regarding potency, cardiovascular events, sodium, and potassium suggests that “CHIP” diuretics [CHlorthalidone, Indapamide and Potassium-sparing diuretic/hydrochlorothiazide (PSD/HCTZ)] might rival RASIs for reducing LVH. Systematic review yielded 37 randomized trials relevant to this hypothesis. For reducing LVH measured as LV mass index (gm/m2), RASIs tended to be superior to diuretics overall, but some trials showed diuretics to be superior to RASIs. These differences among trials (p=0.010) were explained by the diuretic used in each trial: CHIPs surpassed HCTZ for red...