Longitudinal change in left ventricular hypertrophy in the elderly on antihypertensive therapy

Left ventricular hypertrophy is an independent risk factor for adverse cardiovascular events. Factors related to left ventricular hypertrophy progression or regression in the extremely elderly population including role of antihypertensive therapy, are not well recognized. We conducted a structured retrospective chart review analysis of a cohort of 100 homebound elderly, predominately female African American subjects. All persons had at least two 2-D echocardiograms interpreted by the same cardiologist prior to the initiation of this study. Information was collected on demographics, functional status, comorbid conditions, use of medication, and progression or regression of left ventricle hypertrophy between baseline and follow-up echocardiogram. At baseline and follow-up echocardiogram, 47% (n = 47) and 56% had evidence of hypertrophy, respectively. There was no association between treatment with beta-blocker, calcium channel-blocker, or diuretic therapy, and left ventricular hypertrophy at follow-up echocardiogram. Only angiotensin converting enzyme inhibitor therapy was associated with the progression of left ventricular hypertrophy in all subjects. Logistic regression analysis based on all subjects revealed that risk of left ventricular hypertrophy on follow-up echocardiogram was lower with increasing age (OR 0.95, CI 0.904-0.997) and higher with angiotensin converting enzyme inhibitor therapy (OR 3.27, CI 1.41-7.63). Among subjects with no evidence of left ventricular hypertrophy at baseline, only the presence of hypertension was associated with left ventricular hypertrophy (OR 4.4, CI 1.19-16.3). Treatment of hypertension in the elderly with angiotensin converting enzyme inhibitor seemed to worsen left ventricle hypertrophy in this patient population.