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Effect of treatment of isolated systolic hypertension on left ventricular mass
E O Ofili1, J D Cohen, J A St Vrain
1Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Ga 30310, USA.
Insights
Treatment for isolated systolic hypertension (ISH) in the elderly, using a diuretic-based regimen, effectively reduces left ventricular (LV) mass. This intervention demonstrates a significant decrease in LV mass index over three years, unlike placebo.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Left ventricular (LV) hypertrophy is prevalent in elderly individuals with isolated systolic hypertension (ISH).
- The impact of treating ISH on LV mass remains largely uncharacterized.
Purpose of the Study:
- To evaluate the efficacy of antihypertensive drug therapy in reducing LV mass in patients with ISH.
Main Methods:
- The Systolic Hypertension in the Elderly Program (SHEP) employed an echocardiographic substudy.
- 104 elderly participants with ISH underwent baseline echocardiography, with 94 completing 3-year follow-up.
- Participants were randomized to receive either placebo or active treatment (chlorthalidone, with atenolol added as needed).
Main Results:
- Active treatment with chlorthalidone-based regimen led to a 13% decline in LV mass index over 3 years.
- The placebo group experienced a 6% increase in LV mass index during the same period.
- The reduction in LV mass index in the active treatment group was statistically significant compared to placebo (P=.01).
Conclusions:
- Diuretic-based antihypertensive treatment is effective in reducing left ventricular mass in elderly patients with isolated systolic hypertension.
- This finding supports the use of antihypertensive therapy to manage cardiac remodeling in this population.
Context:
Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known.
Objective:
To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH.
Design:
Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP).
Patients:
A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms.
Intervention:
The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure.
Main Outcome Measure:
Change in LV mass assessed by echocardiography.
Results:
Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m2 in the active treatment group and 100 g/m2 in the placebo group (P<.001). The LV mass index declined by 13% (95% confidence interval, - 3% to - 23%) in the active treatment group compared with a 6% increase (95% confidence interval, - 3% to + 16%) in the placebo group over 3 years (P=.01).
Conclusion:
Treatment of ISH with a diuretic-based regimen reduces LV mass.