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Prognostic significance of serial changes in left ventricular mass in essential hypertension
P Verdecchia1, G Schillaci, C Borgioni
1Ospedale Generale Regionale Raffaello Silvestrini, Area Omogenea di Cardiologia e Medicina, Perugia, Italy. verdec@tin.it
Insights
Reducing left ventricular (LV) mass during hypertension treatment is a positive sign for patient outcomes. Lowering LV mass significantly decreases the risk of future cardiovascular events.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Outcomes
Background:
- Elevated left ventricular (LV) mass is a known predictor of adverse outcomes in patients with essential hypertension.
- Understanding the prognostic significance of changes in LV mass during treatment is crucial.
Purpose of the Study:
- To investigate the relationship between changes in left ventricular (LV) mass during antihypertensive therapy and subsequent patient prognosis.
- To determine if a reduction in LV mass predicts a better cardiovascular outcome.
Main Methods:
- Echocardiography and 24-hour ambulatory blood pressure (BP) monitoring were conducted in 430 essential hypertension patients.
- Patient data were analyzed over 1217 patient-years, tracking cardiovascular morbid events.
- Statistical analysis, including Cox proportional hazards models, was used to assess risk factors.
Main Results:
- A decrease in LV mass was associated with a significantly lower rate of cardiovascular events (1.78 per 100 person-years) compared to an increase (3.03 per 100 person-years).
- Reduced LV mass remained a significant predictor of lower cardiovascular risk (HR, 0.46; P=.04) after adjusting for age and baseline electrocardiogram (ECG) findings.
- In patients with baseline LV mass > 125 g/m2, regression of LV hypertrophy (LVH) showed a substantially lower event rate (1.58 vs. 6.27 per 100 person-years; P=.002).
Conclusions:
- A reduction in left ventricular (LV) mass during antihypertensive treatment serves as a favorable prognostic indicator.
- This reduction independently predicts a decreased risk of subsequent cardiovascular morbid events.
- The association between LV mass reduction and improved prognosis is independent of baseline LV mass, BP levels, and BP reduction achieved.
Background:
Increased left ventricular (LV) mass predicts an adverse outcome in patients with essential hypertension. The purpose of this study was to determine the relation between changes in LV mass during antihypertensive treatment and subsequent prognosis.
Methods And Results:
Procedures including echocardiography and 24-hour ambulatory blood pressure (BP) monitoring were performed in 430 patients with essential hypertension before therapy and after 1217 patient-years. Months or years after the follow-up visit, 31 patients suffered a first cardiovascular morbid event. The patients with a decrease in LV mass from the baseline to follow-up visit were compared with those with an increase in LV mass. There were 15 events (1.78 per 100 person-years) in the group with a decrease in LV mass and 16 events (3.03 per 100 person-years) in the group with an increase in LV mass (P=.029). In a Cox model, the lesser cardiovascular risk in the group with a decrease in LV mass (hazard ratio [HR], 0.46; 95% CI, 0.22 to 0.99) remained significant (P=.04) after adjustment for age (HR, 1.06; 95% CI, 1.03 to 1.10; P=.0008) and baseline LVH at ECG (HR, 3.85; 95% CI, 1.52 to 9.78; P=.012). In that model, baseline LV mass bordered on statistical significance (HR, 1.01; 95% CI, 1.00 to 1.03; P=.06). In the subset with LV mass > 125 g/m2 at the baseline visit (26% of subjects), the event rate was lower among the subjects who achieved regression of LVH than in those who did not (1.58 versus 6.27 events per 100 person-years; P=.002). This difference held in the multivariate analysis (HR, 0.18; 95% CI, 0.05 to 0.68).
Conclusions:
In essential hypertension, a reduction in LV mass during treatment is a favorable prognostic marker that predicts a lesser risk for subsequent cardiovascular morbid events. Such an association is independent of baseline LV mass, baseline clinic and ambulatory BP, and degree of BP reduction.