Atherosclerosis and left ventricular hypertrophy: persisting problems in treated hypertensive patients

Area of Science:

• Cardiology
• Vascular Biology
• General Practice Medicine

Background:

• Hypertension is a significant risk factor for cardiovascular disease.
• Atherosclerosis and left ventricular hypertrophy are key indicators of cardiovascular damage.
• Understanding subclinical vascular and cardiac changes in hypertensive patients managed in primary care is crucial.

Purpose of the Study:

• To compare the extent of atherosclerosis and left ventricular hypertrophy in hypertensive versus normotensive patients within general practices.
• To identify modifiable factors associated with these vascular and cardiac outcomes in hypertensive individuals.

Main Methods:

• A case-control study involving 500 hypertensive patients and 506 matched normotensive controls.
• Carotid artery far wall thickness (CWT) assessed by ultrasound and left ventricular mass (LVM) by echocardiography were primary outcome measures.
• Multivariate analyses were used to assess associations with modifiable factors.

Main Results:

• Hypertensive patients, both treated and untreated, exhibited significantly greater CWT (10%) and LVM (14%) compared to normotensive controls.
• Elevated blood pressure and body mass index (BMI) were independently associated with increased CWT and LVM.
• Higher BMI, triglycerides, and lower HDL cholesterol were observed in hypertensive cases.

Conclusions:

• Hypertensive patients managed in general practice have more advanced atherosclerosis and left ventricular hypertrophy than their normotensive counterparts.
• Further blood pressure reduction and BMI management are potential strategies to mitigate these adverse vascular and cardiac changes.
• These interventions may lead to a decreased risk of major cardiovascular events.