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Left ventricular mass and function in primary hypertension
1University of Texas Health Science Center, Department of Medicine/Cardiology, San Antonio 78284-7872, USA.
Insights
This study found that most hypertensive patients have left ventricular hypertrophy, often with diastolic dysfunction, impacting heart function. Optimal blood pressure control may help reverse these changes.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- The J-curve phenomenon in hypertension treatment remains a subject of investigation.
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- Understanding LVH's impact on cardiac function is crucial for patient outcomes.
Purpose of the Study:
- To assess the prevalence of left ventricular mass in hypertensive patients.
- To examine the relationship between left ventricular hypertrophy and cardiac function.
- To correlate echocardiographic findings with clinical events in the Hypertension Optimal Treatment study.
Main Methods:
- Prospective, randomized clinical trial involving 665 hypertensive patients.
- Doppler echocardiography used to assess left ventricular mass, geometry, and systolic/diastolic function.
- Core laboratory rechecking of echocardiographic measurements for accuracy.
Main Results:
- Left ventricular hypertrophy (LVH) was prevalent in 62% of patients, more common in women.
- Concentric hypertrophy was the predominant pattern (46%).
- Diastolic dysfunction was observed in 81% of patients, with constrictive physiology being the most common mitral flow pattern (79%).
Conclusions:
- Hypertensive patients frequently exhibit significant left ventricular hypertrophy and diastolic dysfunction.
- Systolic function indices were generally normal despite LVH.
- Further analysis will compare regression of LVH and diastolic function changes under optimal blood pressure control.
Abstract:
The Hypertension Optimal Treatment study is a prospective, randomized, clinical trial designed to challenge the J curve phenomenon in hypertension. A subpopulation of 665 patients from seven participating centers in the United States were enrolled to evaluate the prevalence of left ventricular mass and its relationship to systolic and diastolic function, as assessed by Doppler echocardiography, and to clinical events during the length of the study. Echocardiographic measurements followed stringent criteria and were rechecked in a core laboratory for accuracy. Baseline data revealed left ventricular hypertrophy in 62% of the patients. Left ventricular hypertrophy was more prevalent in women than in men (72% v 57%, P < .0001). The hypertrophy was further characterized according to left ventricular geometry and found the concentric pattern as the predominant form of hypertrophy (46%). Indices of left ventricular systolic function, including fractional shortening, cardiac index, and ejection fraction, were normal or above-normal. Doppler interrogation of the mitral inflow demonstrated left ventricular diastolic dysfunction in 81% of patients. The constrictive physiology (inversion of the E/A ratio) was the most prevalent mitral flow pattern (79%). Regression of left ventricular hypertrophy, modification of mass index geometry, and alterations in mitral flow characteristics under optimal blood pressure control will be specifically compared with subsequent examinations.