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High-density lipoprotein cholesterol and left ventricular hypertrophy in essential hypertension
G Schillaci1, G Vaudo, G Reboldi
1Unit of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy. skill@unipg.it
Insights
Low high-density lipoprotein (HDL)-cholesterol is linked to increased left ventricular (LV) mass in untreated hypertension. This finding suggests HDL-cholesterol may be an independent predictor of LV mass, impacting prognosis.
Area of Science:
- Cardiology
- Hypertension Research
- Lipid Metabolism
Background:
- Blood pressure explains little of left ventricular (LV) mass variability in essential hypertension.
- Non-hemodynamic factors significantly influence LV mass.
- The relationship between blood lipids and LV mass in hypertensive individuals requires further investigation.
Purpose of the Study:
- To examine the association between blood lipids, specifically high-density lipoprotein (HDL)-cholesterol, and left ventricular (LV) mass in never-treated hypertensive patients.
- To identify independent predictors of LV mass in essential hypertension.
Main Methods:
- Investigated 1306 never-treated, non-diabetic essential hypertensive patients from hospital outpatient clinics.
- Excluded subjects with prior cardiovascular events, diabetes, or current/previous antihypertensive or lipid-lowering therapy.
- Utilized echocardiography to assess LV mass and analyzed associations with HDL-cholesterol and other clinical parameters using univariate and multivariate regression.
Main Results:
- High-density lipoprotein (HDL)-cholesterol showed a significant inverse association with left ventricular (LV) mass (r = -0.30, P < 0.001).
- No significant association was observed between LV mass and total or low-density lipoprotein cholesterol.
- Independent predictors of greater LV mass included average 24-hour blood pressure, body mass index, height, stroke volume, age, and low HDL-cholesterol levels in both sexes.
Conclusions:
- Low high-density lipoprotein (HDL)-cholesterol is an independent predictor of left ventricular (LV) mass in untreated hypertensive subjects.
- This association may be mediated by common hormonal and metabolic factors, potentially including insulin resistance.
- Low HDL-cholesterol levels may contribute to the adverse prognostic significance observed in hypertensive individuals.
Objective:
The proportion of left ventricular (LV) mass variability explained by blood pressure in essential hypertension is small, and several non-haemodynamic determinants of LV mass have been identified or hypothesized. This study examines the possible relation between blood lipids and LV mass in hypertension.
Design:
Never-treated non-diabetic hypertensive patients.
Setting:
Hospital hypertension outpatient clinics in Umbria, Italy.
Patients:
We investigated the association between high-density lipoprotein (HDL)-cholesterol and echocardiographic LV mass in 1306 never-treated subjects with essential hypertension. Subjects with previous cardiovascular events, diabetes and current or previous antihypertensive or lipid-lowering therapy were excluded.
Results:
HDL-cholesterol showed an inverse association with LV mass (r = -0.30, P < 0.001). No association was found between LV mass and total or low-density lipoprotein cholesterol. With multiple linear regression analysis we tested the independent contribution of several potential determinants of LV mass in women and in men. Average 24 h blood pressure (both pulse and mean), body mass index, height, stroke volume, age (all P < 0.01) and low HDL-cholesterol (P < 0.0001 in women, P < 0.001 in men) were associated with a greater LV mass in both sexes. Triglycerides showed a weak univariate association with LV mass in women (r = 0.11, P < 0.02), which did not hold in a multivariate analysis.
Conclusions:
Low HDL-cholesterol is an independent predictor of LV mass in untreated hypertensive subjects. Common hormonal and metabolic mechanisms, including insulin resistance, could explain this association, which may contribute to the adverse prognostic significance of low HDL-cholesterol levels.