Angiotensin Receptor Blockers Versus Amlodipine Therapy For Left Ventricular Hypertrophy: A Systematic Review

Objective: To systematically evaluate the efficacy and safety ofAngiotensin receptor blockers（ARB）versus amlodipine in the treatment ofleft ventricular hypertrophy（LVH） in essential hypertension patients. so asto provide the basis to choose appropriate drugs for treating patients withLVH.Methods: The databases were electronically retrieved，including TheCochrane Library, MEDLINE,EMBASE,OVID,PubMed,CBM,CHKD,VIPand Wan Fang (by the end of December2013), then the online resourceswere expand searched, such as Baidu and Google. Finally the relevantmagazines were retrieved manually and the related references were tracked.Studies were filtered according to the Pre-defined inclusion and exclusioncriteria. Randomized controlled trials (RCTs) on Angiotensin receptorblockers（ARB）versus Amlodipine for left ventricular hypertrophy inessential hypertension patients were included. Relevant information wasextracted independently by two authors. The methodological quality ofincluded studies was evaluated by method recommended by the CochraneHandbook and then data analyses were conducted using RevMan5.2software.Results: A total of29RCTs were included. The period of treatmentwas1month to3years. The results of meta-analyses showed that: compared with the Angiotensin receptor blockers（ARB）and Amlodipine groups therewas no significant difference to reduce systolic blood pressure（SBP）[MD=0.16，95%C（I-0.76，1.08），P=0.73] and diastolic blood pressure(DBP)[MD=-0.56，95%CI（-1.20，0.07），P=0.08], it was similar in controllingblood pressure. However, there was a significant difference in reductionsof Left ventricular mass index （LVMI）[MD=9.65,95%CI(3.73,15.58),P=0.001] and Left ventricular posterior wallthickness（LVPWT）[MD=0.92,95%CI (0.56,1.29),P=0.00001] betweenARB and Amlodipine groups. ARB play a significant role of reversed LVH.The incidence of adverse effects was significant difference between the ARBgroup and the amlodipine group [OR=0.56，95%CI（0.37，0.85），P=0.007].Conclusion: It was similar in controlling blood pressure between ARBand Amlodipine groups. ARB is superior to the amlodipine in regression ofLVH, and has fewer adverse reactions. However, Larger sample, higherqualityand double blind RCTs are needed to confirm the conclusion.