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Left ventricular mass as a measure of preclinical hypertensive disease
R B Devereux1, M J Koren, G de Simone
1Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
Insights
Left ventricular mass, measured by echocardiography, is a better predictor of hypertension complications than blood pressure. Assessing LV mass may improve patient treatment and outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Identifying patients at risk for severe hypertension complications is challenging due to weak correlation between blood pressure and outcomes.
- Left ventricular (LV) mass reflects multiple pathophysiological factors in hypertension.
Purpose of the Study:
- To evaluate the predictive value of left ventricular mass in hypertensive patients.
- To explore the relationship between LV mass, arterial disease, and treatment response.
Main Methods:
- Echocardiography for measuring left ventricular mass.
- Prospective studies analyzing morbid events and mortality.
- Assessment of arterial disease and changes in LV mass during treatment.
Main Results:
- LV mass is a stronger predictor of morbid events and death than blood pressure, except for age.
- Preliminary data show links between LV mass, arterial disease, and treatment outcomes.
- Changes in LV mass during antihypertensive therapy correlate with subsequent events.
Conclusions:
- Left ventricular mass is a significant predictor of cardiovascular events in hypertension.
- Further research is needed to understand the biological basis and clinical application of LV mass stratification in hypertension management.
Abstract:
The ability to identify the hypertensive patient who is destined to suffer a morbid or fatal complication in the long presymptomatic phase of this condition, when its natural history would be most subject to amelioration, is limited by the weak relation between the level of blood pressure and the occurrence of complications. Recent research indicates that the level of left ventricular (LV) mass--most conveniently measured by echocardiography--reflects the combined effects of a variety of factors involved in the pathophysiology of hypertension, including obesity, exaggerated blood pressure responses to everyday activity, high sodium intake and blood viscosity, and genetic factors predisposing to hypertension. Prospective studies indicate that LV mass is a stronger predictor of subsequent morbid events and death than blood pressure or other conventional risk factors except age. Preliminary findings of close relations between LV mass and arterial disease and between the change in LV mass during antihypertensive treatment and subsequent events contribute to explaining the strong predictive value of LV mass. Further research is needed to clarify the biologic basis of these observations and to determine whether stratification of hypertensive patients based on their level of LV mass can improve the treatment of hypertension.