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Longitudinal change in left ventricular hypertrophy in the elderly on antihypertensive therapy
Aftab Ahmad1, Hafsa M Nawaz, Linda Nevins
1Visiting Physicians Association, Southfield, MI, USA.
Insights
In elderly African Americans, angiotensin converting enzyme inhibitor therapy was linked to worsening left ventricular hypertrophy. Other antihypertensives showed no association, suggesting careful consideration of ACE inhibitors in this population.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular events.
- Factors influencing LVH progression or regression in the very elderly, particularly regarding antihypertensive therapy, are not well understood.
Purpose of the Study:
- To investigate factors associated with left ventricular hypertrophy progression or regression in homebound elderly African Americans.
- To examine the role of specific antihypertensive therapies in LVH changes in this population.
Main Methods:
- Retrospective chart review of 100 homebound elderly African American subjects.
- Analysis of demographic data, functional status, comorbidities, medications, and serial 2-D echocardiograms.
- Logistic regression analysis to identify factors associated with LVH at follow-up.
Main Results:
- 47% and 56% of subjects had LVH at baseline and follow-up, respectively.
- No association was found between beta-blocker, calcium channel-blocker, or diuretic therapy and LVH.
- Angiotensin converting enzyme inhibitor (ACE inhibitor) therapy was associated with LVH progression (OR 3.27).
- Increasing age was associated with lower risk of LVH (OR 0.95).
- Hypertension was associated with LVH in subjects without baseline hypertrophy (OR 4.4).
Conclusions:
- ACE inhibitor therapy may worsen left ventricular hypertrophy in elderly African Americans.
- Age and hypertension are significant factors in LVH development in this population.
- Further research is needed to clarify the role of ACE inhibitors in elderly cardiovascular health.
Abstract:
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.