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Allopurinol treatment adversely impacts left ventricular mass regression in patients with well-controlled hypertension.


ABSTRACT: OBJECTIVES:Previous studies have demonstrated that high-dose allopurinol is able to regress left ventricular (LV) mass in cohorts with established cardiovascular disease. The aim of this study was to assess whether treatment with high-dose allopurinol would regress LV mass in a cohort with essential hypertension, LV hypertrophy and well-controlled blood pressure but without established cardiovascular disease. METHODS:We conducted a mechanistic proof-of-concept randomized, placebo-controlled, double-blind trial of allopurinol (600?mg/day) versus placebo on LV mass regression. Duration of treatment was 12 months. LV mass regression was assessed by Cardiac Magnetic Resonance. Secondary outcomes were changes in endothelial function (flow-mediated dilatation), arterial stiffness (pulse wave velocity) and biomarkers of oxidative stress. RESULTS:Seventy-two patients were randomized into the trial. Mean baseline urate was 362.2?±?96.7??mol/l. Despite good blood pressure control, LV mass regression was significantly reduced in the allopurinol cohort compared with placebo (LV mass -0.37?±?6.08 versus -3.75?±?3.89?g; P?=?0.012). Oxidative stress markers (thiobarbituric acid reactive substances) were significantly higher in the allopurinol group versus placebo (0.26?±?0.85 versus -0.34?±?0.83??mol/l; P?=?0.007). Other markers of vascular function were not significantly different between the two groups. CONCLUSION:Treatment with high-dose allopurinol in normouricemic controlled hypertensive patients and LV hypertrophy is detrimental. It results in reduced LV mass regression and increased oxidative stress over a 12-month period. This may be because of an adverse impact on redox balance. Cohort selection for future cardiovascular trials with allopurinol is crucial.

SUBMITTER: Gingles CR 

PROVIDER: S-EPMC6855336 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Allopurinol treatment adversely impacts left ventricular mass regression in patients with well-controlled hypertension.

Gingles Christopher R CR   Symon Ruth R   Gandy Stephen J SJ   Struthers Allan D AD   Houston Graeme G   MacDonald Thomas M TM   Lang Chim C CC   Donnan Peter T PT   George Jacob J  

Journal of hypertension 20191201 12


<h4>Objectives</h4>Previous studies have demonstrated that high-dose allopurinol is able to regress left ventricular (LV) mass in cohorts with established cardiovascular disease. The aim of this study was to assess whether treatment with high-dose allopurinol would regress LV mass in a cohort with essential hypertension, LV hypertrophy and well-controlled blood pressure but without established cardiovascular disease.<h4>Methods</h4>We conducted a mechanistic proof-of-concept randomized, placebo-  ...[more]

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