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Increased risk attributed to left ventricular hypertrophy in hypertension
1Hypertension Unit, University of Ottawa Heart Institute, Ontario, Canada.
Insights
Left ventricular mass and geometry may not be independent cardiovascular risk factors. Blood pressure load is a more reliable predictor of prognosis in hypertensive individuals, especially with mild to moderate hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular mass and geometry are established predictors of cardiovascular events.
- Previous studies suggested these factors are independent risk factors for cardiovascular morbidity.
- Recent research questions the independence of these factors from blood pressure load and other risks.
Purpose of the Study:
- To evaluate the independent predictive value of left ventricular mass and geometry on cardiovascular outcomes.
- To assess the role of echocardiographic measurements versus blood pressure load in determining prognosis for hypertensive patients.
Main Methods:
- Review of recent studies (1-2 years) challenging the independent risk status of left ventricular mass and geometry.
- Analysis of echocardiographic measurement variability and its impact on assessing left ventricular mass.
- Evaluation of the prognostic significance of blood pressure load in hypertension.
Main Results:
- Left ventricular mass may not be an independent risk factor, being dependent on blood pressure load.
- Left ventricular geometry's independence is questioned, potentially influenced by left ventricular mass and other risk factors.
- Echocardiography's limitations in assessing true left ventricular mass affect individual prognosis, particularly in mild to moderate hypertension.
Conclusions:
- The independent predictive value of left ventricular mass and geometry for cardiovascular events is debated.
- Blood pressure load is currently considered the most reliable indicator for assessing prognosis in hypertensive individuals.
- Accurate assessment of blood pressure load is crucial for managing hypertensive patients and predicting cardiovascular outcomes.
Abstract:
Both left ventricular mass and left ventricular geometry have been identified as predictors of cardiovascular morbid events. Several studies have suggested that they represent independent risk factors. Studies reported in the past 1 to 2 years have challenged this concept, ie, left ventricular mass may not be a risk factor independent of actual blood pressure load, and left ventricular geometry may not be independent from left ventricular mass and other risk factors. Because of the variability in echocardiographic measurements, echocardiography provides a limited assessment of the actual left ventricular mass in an individual, and therefore of this individual's prognosis, particularly in subjects with mild to moderate hypertension. At present, careful assessment of blood pressure load remains the mainstay for assessment of prognosis of hypertensive subjects.