ABC | Volume 112, Nº1, January 2019

Brief Communication Bertoluci et al Diuretics and losartan in stage I hypertension Arq Bras Cardiol. 2019; 112(1):87-90 Table 2 – Adjusted differences in blood pressure and echocardiographic parameters between diuretics (chlorthalidone/amiloride) and losartan treatment groups* Variable Drug Baseline 18-Month Follow-Up Change from baseline p Between group change p Adjusted between group change** p SBP (mmHg) Diuretics 142.2 ± 8.2 129.8 ± 10.0 -12.4 ± 11.1 < 0.001 2.7 0.18 1.18 0.51 Losartan 139.4 ± 6.0 129.7 ± 8.7 -9.7 ± 9.4 < 0.001 DPB (mmHg) Diuretics 90.6 ± 5.9 83.7 ± 7.0 -6.8 ± 5.9 < 0.001 1.2 0.33 0.77 0.49 Losartan 90.2 ± 5.6 82.1 ± 6.8 -8.0 ± 6.6 < 0.001 LVMI (g/m 2 ) Diuretics 84 ± 17 81 ± 19 -3 ± 16 0.11 1.78 0.48 3.84 0.14 Losartan 82 ± 17 77 ± 16 -4 ± 14 0.02 IVST (mm) Diuretics 10.0 ± 1.2 9.7 ± 1.3 -0.3 ± 1.2 0.03 0.34 0.13 0.60 0.009 Losartan 10.0 ± 1.1 9.4 ± 1.2 -0.7 ± 1.1 < 0.001 PWT (mm) Diuretics 10.1 ± 1.1 9.5 ± 1.1 -0.6 ± 3.3 < 0.001 -0.13 0.47 0.16 0.38 Losartan 9.8 ± 1.1 9.4 ± 1.0 -0.46 ± 1.1 0.002 RWT Diuretics 0.45 ± 0.06 0.42 ± 0.05 -0.04 ± 0.06 < 0.001 -0.009 0.47 0.007 0.53 Losartan 0.44 ± 0.06 0.41 ± 0.05 -0.03 ± 0.07 0.006 LAVI (ml/m 2 ) Diuretics 25.4 ± 6.5 24.1 ± 6.9 -1.4 ± 6.2 0.12 1.24 0.28 0.26 0.83 Losartan 28.2 ± 7.8 25.7 ± 5.9 -2.6 ± 5.2 0.001 Medial E/e’ ratio Diuretics 8.1 ± 2.1 8.5 ± 2.6 0.42 ± 2.52 0.23 0.61 0.21 0.22 0.65 Losartan 8.8 ± 2.3 8.6 ± 2.3 -0.19 ± 2.39 0.57 EDT (ms) Diuretics 229.2 ± 47.4 252.2 ± 67.2 23.0 ± 63.0 0.01 11.0 0.37 13.33 0.34 Losartan 230.0 ± 45.4 243.8 ± 66.9 12.0 ± 64.2 0.19 * Diuretics: n = 56; Losartan: n = 54. ** Analysis of covariance adjusted for mean blood pressure variation, corresponding baseline echocardiographic parameter and time between randomization and echocardiographic exam. Diuretics: chlorthalidone/amiloride; SBP: systolic blood pressure; DBP: diastolic blood pressure; LVMI: left ventricular mass index; IVST: interventricular septum thickness; PWT: posterior wall thickness; RWT: relative wall thickness; LAVI: left atrial volume index; EDT: E-wave deceleration time. Data are expressed as mean ± SD. channel blockers, angiotensin-converting enzyme inhibitors and ARB had similar effectiveness. We showed that there was no difference on LV mass regression after 18 months between a diuretic-based versus an ARB-based treatment of patients with stage I hypertension. The study limitations shouldbe acknowledged. The anticipated breach in randomization is not likely to have impacted the results, as demographic characteristics of the studied sample and the magnitude of SBP reduction were similar to those achieved in the whole sample study. Also, study power could be underestimated to find statistically significant differences in echocardiographic parameters between randomized treatments, as the PREVER‑treatment study sample size was estimated for its primary endpoint. These potential limitations, however, reinforce the reported findings, which are even more noticeable if we consider the relatively lowburden of hypertension organ damage, and the follow-up of only 18 months. Conclusion In stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters of target- organ damage, with a favorable LV remodeling achieved with either diuretics or losartan as the initial treatment strategy. Author contributions Conception and design of the research, analysis and interpretation of the data and statistical analysis: Bertoluci C, Foppa M, Fuchs SC, Fuchs FD; acquisition of data: Bertoluci C, Foppa M; obtaining funding: Fuchs SC, Fuchs FD; writing of the manuscript and critical revision of the manuscript for intellectual content: Bertoluci C, Foppa M, Santos ABS, Fuchs SC, Fuchs FD. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by DECIT, CNPq, FINEP, IATS and FIPE do Hospital de Clínicas de Porto Alegre. Study Association This article is part of the thesis of Doctoral submitted by Carolina Bertoluci, from Universidade Federal do Rio Grande do Sul. 89