Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE study.

Objective To compare the efficacy of indapamide sustained release (SR) 1.5 mg and enalapril 20 mg at reducing left ventricular mass index (LVMI) in hypertensive patients with left ventricular hypertrophy (LVH). Design The LIVE study (left ventricular hypertrophy regression, indapamide versus enalapril) was a 1 year, prospective, randomized, double-blind study. For the first time, a committee validated LVH before inclusion, provided on-going quality control during the study, and performed an end-study reading of all echocardiograms blinded to sequence. Setting European hospitals, general practitioners and cardiologists. Patients Hypertensive patients aged ≥ 20 years with LVH (LVMI in men > 120 g/m 2 ; LVMI in women > 100 g/m 2 ). Data were obtained from 411 of 505 randomized patients. Interventions Indapamide SR 1.5 mg, or enalapril 20 mg, daily for 48 weeks. Main outcome measures LVMI variation in the perprotocol population. Results Indapamide SR 1.5 mg significantly reduced LVMI (-8.4 ± 30.5 g/m 2 from baseline; P< 0.001), but enalapril 20 mg did not (-1.9 ± 28.3 g/m 2 ). Indapamide SR 1.5 mg reduced LVMI significantly more than enalapril 20 mg: -6.5 g/m 2 , P = 0.013 (-4.3 g/m 2 when adjusted for baseline values; P=0.049). Both drugs equally and significantly reduced blood pressures (P< 0.001), without correlation with LVMI changes. Indapamide SR progressively reduced wall thicknesses throughout the 1-year treatment period. In contrast, the effect of enalapril observed at 6 months was not maintained at 12 months. Conclusions Indapamide SR 1.5 mg was significantly more effective than enalapril 20 mg at reducing LVMI in hypertensive patients with LVH.