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Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients: The Campania Salute Network
Raffaele Izzo1, Maria-Angela Losi1, Eugenio Stabile1
1From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.).
Insights
Even with treatment, hypertension can lead to left ventricular hypertrophy (LVH). Obesity and female sex increase LVH risk in treated hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) development during antihypertensive treatment is poorly understood.
- Understanding factors influencing LVH is crucial for managing hypertension and cardiovascular risk.
Purpose of the Study:
- To evaluate the incidence of LVH in a treated hypertensive cohort.
- To identify risk factors for incident LVH in patients receiving antihypertensive therapy.
Main Methods:
- Prospective analysis of 4290 hypertensive patients from the Campania Salute Network registry.
- Follow-up of at least 1 year, with incident LVH defined by echocardiographic LV mass index.
- Multivariable Cox regression analysis to identify independent predictors of LVH.
Main Results:
- Over a median of 48 months, 21.3% of patients developed incident LVH.
- Older age, female sex, obesity, higher average systolic blood pressure, and initial LV mass index were associated with increased LVH risk.
- Obesity independently increased LVH risk in both men and women.
Conclusions:
- Despite antihypertensive therapy, a significant proportion of patients develop LVH.
- Female sex and obesity are significant independent risk factors for incident LVH.
- Risk stratification considering sex and obesity is important for managing hypertensive patients.
Abstract:
There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca++-channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients according to obesity and sex, obesity independently increased the risk for incident LVH in both sexes (obese versus nonobese men: hazard ratio, 1.34; confidence interval, 1.05-1.72; P=0.019; and obese versus nonobese women: hazard ratio, 1.34; confidence interval, 1.08-1.66; P=0.007). Despite more aggressive antihypertensive therapy, 21% of hypertensive patients develop clear-cut LVH. After adjusting for confounders, risk of incident LVH is particular relevant among women and is further increased by the presence of obesity.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02211365.