Trends in hypertension control and left ventricular hypertrophy over three years

The aim of this study was to describe trends in blood pressure (BP) control and in the prevalence of left ventricular hypertrophy (LVH) during 3 years of follow-up in a representative sample of treated hypertensive patients seen in our out-patient hypertension hospital clinic.

Four hundred and sixty-four hypertensive treated patients who took part in a clinical survey at our out-patient clinic during the year 1997 and who had been submitted to a routine follow-up visit 3 years later were included in the study. All patients were subjected to the following procedures: an accurate medical history, physical examination, electrocardiogram, clinical BP measurement. For the diagnosis of LVH we used two different ECG criteria: the Solokow-Lyon voltage and the gender-specific Cornell voltage.

During the first survey, 15% of treated patients had a clinical BP < 130/85 mmHg, 25.1% > or = 130/85 mmHg and < 140/90 mmHg, 33.6% > or = 140/90 and < 150/95 mmHg, 26.3% > or = 150/95 mmHg. The corresponding figures in the second survey were 19, 26.7, 33.2 and 21.1%, respectively. Overall, from the first to the second survey the prevalence of an effective BP control (< 140/90 mmHg) rose from 40.1 to 46.7% (p < 0.01). At baseline, 40 patients had ECG LVH (8.6%); at the second visit, LVH was found to have regressed in 19 of these patients. Among the 424 patients with a normal baseline electrocardiogram, 3 developed LVH during follow-up. Hence, the prevalence of LVH decreased from 8.6 to 5.1% (p < 0.01). In terms of treatment, the prevalence of combination therapy regimens increased from 68.6 to 79.7% (p < 0.05).

This study demonstrates that in hypertensive patients managed in a hypertension hospital clinic, BP control improved during the long-term follow-up and that this trend was associated with a significant regression in ECG LVH.