Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension

Area of Science:

• Cardiology
• Hypertension Research
• Diagnostic Imaging

Background:

• Left ventricular (LV) hypertrophy detected by echocardiography is a known risk indicator in essential hypertension.
• The prognostic significance of LV mass within the "normal" range and the nature of the LV mass-prognosis relationship remain unclear.

Purpose of the Study:

• To investigate the prognostic impact of LV mass values, including those within the "normal" range, in essential hypertension.
• To determine the shape of the relationship between LV mass and cardiovascular risk and all-cause mortality.

Main Methods:

• 1925 white subjects with uncomplicated essential hypertension underwent off-therapy 24-hour ambulatory blood pressure monitoring and M-mode echocardiography.
• Follow-up duration was 4.0 ± 2 years, during which major cardiovascular events and all-cause deaths were recorded.
• LV mass was analyzed across gender-specific quintiles, and relative risks (RR) were calculated after adjusting for multiple risk factors.

Main Results:

• Cardiovascular event rates increased progressively across LV mass quintiles, from 0.8 to 4.3 per 100 patient-years.
• Adjusted analysis revealed a continuous increase in cardiovascular event risk from the lowest to the highest LV mass quintile (RR 1 to 3.5).
• The highest LV mass quintile showed a significantly increased risk for all-cause death (RR 4.3) compared to the lowest quintile.

Conclusions:

• A continuous and significant relationship exists between LV mass and cardiovascular disease risk in essential hypertension, extending to values below current "upper normal" limits.
• This association remains significant even after controlling for traditional risk factors, including ambulatory blood pressure.
• Echocardiographic assessment of LV mass provides crucial prognostic information across a broad spectrum of values in hypertensive patients.