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Left ventricular hypertrophy and hypertension
R B Devereux1, G de Simone, A Ganau
1Division of Cardiology, New York Hospital, Cornell Medical Center, NY 10021.
Insights
Left ventricular (LV) hypertrophy in hypertensive patients significantly increases cardiovascular risk. Assessing LV geometry aids in risk stratification and guides treatment decisions for better patient outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular (LV) mass in hypertensive patients is influenced by arterial pressure, volume load, arterial waveform, body size, and non-hemodynamic factors.
- The LV can adapt through concentric or eccentric hypertrophy, or concentric remodeling, altering cardiac structure in response to hypertension.
Purpose of the Study:
- To investigate the prognostic value of left ventricular geometry in hypertensive patients.
- To determine if LV geometry assessment improves cardiovascular risk stratification beyond traditional measures.
Main Methods:
- Echocardiography and other techniques were used to measure LV mass and geometry.
- Analysis included correlation with cardiovascular morbid events and comparison with WHO hypertension severity classification.
Main Results:
- Eccentric and concentric LV hypertrophy are associated with a two- to four-fold increase in cardiovascular morbid events compared to normal LV geometry.
- LV geometry assessment provides stronger prognostic prediction than indirect measures of target organ status in hypertension.
Conclusions:
- Evaluation of LV geometry is crucial for accurate cardiovascular risk stratification in hypertensive patients.
- Assessing LV geometry can enhance clinical decision-making regarding the initiation and type of treatment for hypertension.
Abstract:
The level of left ventricular (LV) mass as measured by echocardiography or other techniques in hypertensive patients reflects the integrated effects of the level of arterial pressure, the concomitant volume load imposed on the heart, and of alterations in arterial waveform morphology as well as of body size and non-hemodynamic variables. The LV may respond to these stimuli by concentric or eccentric hypertrophy or by the recently-described pattern of concentric remodeling, in which LV mass is normal but relative wall thickness is increased. The are strong parallelisms between increases in cardiac and systemic arterial wall thicknesses, and patients with discrete atheromas detectable by carotid ultrasound have elevated LV masses. Patients with eccentric and concentric LV hypertrophy have two to four-fold increases in the incidence of cardiovascular morbid events compared to hypertensive patients with normal LV geometry, and the change in LV mass during treatment has been associated with the risk of subsequent morbidity in initial studies. In contrast to the strong predictive power of LV geometric assessment, use of indirect measures of target organ status in the WHO system for classification of the severity of hypertension does not improve on the prediction of prognosis that can be obtained by consideration of the level of arterial pressure. Current evidence suggests that evaluation of LV geometry may contribute to improved clinical decision-making in situations where more precise stratification of risk would clarify whether or not to institute treatment, or whether it should be with drugs or non-pharmacologic measures.