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Left ventricular concentric remodelling and extracardiac target organ damage in essential hypertension
1Istituto di Clinica Medica e Terapia Medica and Centro di Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Milano, Italy.
Insights
Left ventricular concentric remodelling in hypertension does not increase extracardiac target organ damage. Patients with normal geometry and remodelling showed similar levels of organ damage, suggesting remodelling alone is not a marker for further complications.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Imaging
Background:
- Left ventricular (LV) concentric remodelling is a common cardiac adaptation in arterial hypertension.
- Understanding its association with extracardiac target organ damage (TOD) is crucial for risk stratification.
Purpose of the Study:
- To investigate the extent of extracardiac TOD in never-treated essential hypertensive patients with LV concentric remodelling compared to those with normal LV geometry.
- To determine if LV concentric remodelling is an independent predictor of TOD in hypertension.
Main Methods:
- Two matched groups of never-treated essential hypertensives were studied: 31 with normal LV geometry and 31 with LV concentric remodelling.
- Assessments included clinical evaluation, 24-h ambulatory BP monitoring, microalbuminuria, retinal photography, echocardiography, and carotid ultrasonography.
Main Results:
- Groups were similar in age, BMI, blood pressure, LV mass index, carotid intima-media thickness, and carotid plaque prevalence.
- No significant differences were found in the prevalence of retinal changes or microalbuminuria between the groups.
Conclusions:
- In hypertensive patients with comparable blood pressure and LV mass index, LV concentric remodelling is not associated with increased extracardiac target organ damage.
- LV concentric remodelling may not be an independent risk factor for TOD in this specific hypertensive population.
Abstract:
Left ventricular (LV) concentric remodelling is an adaptive change in cardiac geometry frequently observed in arterial hypertension. This study was addressed to investigate the extent of extracardiac target organ damage (TOD) in patients with LV concentric remodelling. Two groups of never-treated essential hypertensives, 31 with normal LV geometry (group I, relative wall thickness: 0.39) and 31 with LV concentric remodelling (group II, relative wall thickness: 0.47) matched for age, sex, body mass index and mean 24-h systolic blood pressure (BP), were included in the study. They underwent clinical and laboratory examination, 24-h ambulatory BP monitoring (ABPM), 24-h urinary collection for microalbuminuria, non-mydriatic photography of ocular fundi, echocardiography and carotid ultrasonography. In both groups age (I: 51 +/- 11 years; II: 51 +/- 11 years), body mass index (I: 25 +/- 3 kg/m(2); II: 26 +/- 3 kg/m(2)), clinic and 24-h ABPM values (I: 149 +/- 11/95 +/- 8, 142 +/- 11/91 +/- 7 mm Hg; II: 150 +/- 11/98 +/- 9, 142 +/- 12/92 +/- 9 mm Hg) were similar by design. There were no differences between patients with normal LV geometry and with LV concentric remodelling in LVM index (97 +/- 16 vs 99 +/- 16), carotid intima-media thickness (0.7 +/- 0.02 vs 0.7 +/- 0.02) and carotid plaques prevalence (35% vs 35%). Furthermore, no significant differences among the two groups were found in the prevalence of retinal changes and microalbuminuria. These results suggest that in hypertensive patients with similar BP and LVMI levels, LV concentric remodelling is not associated with more prominent TOD.