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Persistence of increased left ventricular mass despite optimal blood pressure control in hypertension
G Schillaci1, P Verdecchia, G de Simone
1Division of Medicine, Hospital Beato G. Villa, Città della Pieve, Italy. skill@ftbcc.it
Insights
Even with normalized blood pressure, hypertensive patients retain greater left ventricular mass compared to healthy individuals. This suggests factors beyond blood pressure influence cardiac remodeling in treated essential hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) is a significant risk marker in essential hypertension.
- Regression of LVH favorably impacts prognosis.
- The complete normalization of left ventricular mass following long-term blood pressure normalization remains unclear.
Purpose of the Study:
- To investigate whether long-term blood pressure normalization in essential hypertension leads to complete normalization of left ventricular mass.
- To compare left ventricular mass in treated hypertensive patients with normalized blood pressure to matched healthy normotensive controls.
Main Methods:
- Prospective cohort study with a case-control design.
- 107 hypertensive patients with normalized blood pressure (clinic BP < 140/90 mmHg) under long-term treatment were matched with 107 healthy controls.
- 24-hour blood pressure monitoring and M-mode echocardiography were performed on all subjects.
Main Results:
- No significant differences were observed in age, BMI, clinic BP, or 24-hour BP between hypertensive patients and controls.
- Left ventricular mass was significantly greater in treated hypertensive patients (97 ± 24 g/m²) compared to normotensive controls (86 ± 17 g/m²).
- Relative wall thickness was also significantly higher in the hypertensive group (0.40 ± 0.08 vs. 0.37 ± 0.08).
Conclusions:
- Well-controlled hypertensive patients exhibit greater left ventricular mass than matched normotensive individuals.
- This persistent LVH may explain the lower-than-expected reduction in coronary heart disease risk observed during antihypertensive therapy.
- Hemodynamic and/or non-hemodynamic factors beyond blood pressure may contribute to sustained left ventricular mass in treated essential hypertension.
Background:
Left ventricular hypertrophy is an adverse risk marker in essential hypertension and its regression has a favorable effect on prognosis. It is unclear whether blood pressure normalization induced by long-term therapy is able to normalize left ventricular mass completely.
Methods:
In the setting of a prospective cohort study, 107 consecutive hypertensive patients who achieved blood pressure normalization (clinic blood pressure < 140/90 mmHg on > or = 3 consecutive visits) under long-term (1-10 years, average 2.9) drug treatment were individually matched with 107 healthy normotensive controls by gender, age (+/- 5 years), body mass index (+/- 3 kg/m2), and clinic systolic blood pressure (+/- 5 mmHg) in a case-control design. All subjects underwent 24-hour blood pressure monitoring and M-mode echocardiography.
Results:
Treated hypertensive patients and normotensive controls did not differ by age, body mass index, clinic blood pressure (128/82 vs 128/81 mmHg), and 24-hour blood pressure (120/77 vs 120/76 mmHg). Left ventricular mass and relative wall thickness were greater in the hypertensive than in the normotensive group (97 +/- 24 vs 86 +/- 17 g/m2 and 0.40 +/- 0.08 vs 0.37 +/- 0.08, both p < 0.001).
Conclusions:
Left ventricular mass is greater in well-controlled hypertensive patients than in normotensive controls matched by age, obesity, gender, and clinic and 24-hour blood pressure. This finding is consistent with the lower than epidemiologically expected reduction in coronary heart disease risk during antihypertensive therapy and might reflect the persistent effect on left ventricular mass of hemodynamic and/or non-hemodynamic factors other than blood pressure in treated patients with essential hypertension.