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Left ventricular mass change during treatment and outcome in patients with essential hypertension
Michael J Koren1, Roy J Ulin, Andrew T Koren
1Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York, USA.
Insights
Reducing left ventricular (LV) mass during hypertension treatment lowers cardiovascular risks. Regression of LV hypertrophy is a stronger predictor of outcomes than blood pressure changes.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Uncertainty exists regarding the predictive value of left ventricular (LV) mass reduction for cardiovascular complications during antihypertensive therapy.
- Essential hypertension management aims to prevent long-term adverse cardiovascular events.
Purpose of the Study:
- To investigate whether reduction in left ventricular (LV) mass during antihypertensive treatment is associated with a decreased rate of cardiovascular complications.
- To determine the prognostic significance of LV mass changes and LV hypertrophy regression or development during treatment.
Main Methods:
- Prospective study of 172 patients with essential hypertension, monitored over an average of 10.3 years (5.5 years between echocardiograms, plus 4.8 years follow-up).
- Echocardiograms were used to assess left ventricular (LV) mass at baseline and follow-up.
- Antihypertensive treatment was managed by primary physicians; cardiovascular events were recorded.
Main Results:
- Patients whose LV mass increased during follow-up had a higher rate of cardiovascular events (19.8%) compared to those with unchanged or decreased LV mass (8.8%) (P=.04).
- Absence of LV hypertrophy on follow-up echocardiography was the strongest predictor of lower subsequent morbid event rates (9.2%) versus presence of LV hypertrophy (28.6%) (P=.004).
- Multivariate analysis identified LV mass index at follow-up as the sole consistent predictor of adverse outcomes.
Conclusions:
- Reduction in left ventricular (LV) mass during antihypertensive treatment correlates with a lower rate of essential hypertension complications.
- The development or regression of LV hypertrophy during treatment appears more strongly linked to patient prognosis than changes in clinic blood pressure.
Background:
It is uncertain whether reduction of left ventricular (LV) mass during antihypertensive treatment predicts reduces cardiovascular complications of hypertension.
Methods:
A total of 172 prospectively identified patients with essential hypertension without complications of hypertension at baseline and follow-up echocardiograms 5.5 +/- 3.0 years apart, were followed an additional 4.8 +/- 2.9 years. Antihypertensive treatment was determined by primary physicians.
Results:
After the second echocardiograms, cardiovascular events occurred in 24 patients (14%). Fewer of the 91 patients with unchanged or decreased LV mass experienced cardiovascular events than of the 81 patients whose LV mass increased during follow-up (8.8% [95% confidence interval (CI): 3.9%-13.7%] v 19.8% [95% CI 12.6%-27.0%]; P =.04) despite greater baseline LV mass in the former group (118 g/m(2) [95% CI 111-125] v 95 g/m(2) [95% CI 88-102]; P <.0001). Absence or presence of LV hypertrophy on the follow-up echocardiogram was the strongest predictor of relatively low (9.2% [95% CI 5%-13.4%]) v high (28.6% [95% CI 17.1%-40.1%]; P =.004) rates of subsequent morbid events. In multivariate analyses, only LV mass index at follow-up consistently predicted adverse outcomes.
Conclusions:
The LV mass reduction during antihypertensive treatment is associated with reduced rate of complications of essential hypertension. Our data further suggest that development or regression of LV hypertrophy during antihypertensive treatment may be more closely linked to prognosis than are changes in clinic blood pressure.