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      Impact of Blood Pressure Control on Prevalence of Left Ventricular Hypertrophy in Treated Hypertensive Patients

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          Abstract

          Aim: The aim of the present study was to evaluate (1) the prevalence and patterns of left ventricular hypertrophy (LVH) and (2) the impact of blood pressure (BP) control, assessed by clinical and 24-hour ambulatory BP monitoring (ABPM) criteria on the persistence of LVH in a representative sample of treated patients attending our Hypertension Clinic. Methods: One hundred consecutive essential hypertensives (61 m/39 f, age 56± 9 years) regularly followed up by the same medical team (average period 52 months, 12–156 months) were included in the study and underwent 24-hour ABPM and complete echocardiographic examination. Results: Twenty-eight of the 100 patients were found to have LVH [left ventricular mass index (LVMI) >125 g/m<sup>2</sup> in men and >110 g/m<sup>2</sup> in women]; LVH was eccentric in 20 patients and concentric in the remaining 8. LVMI did not correlate with clinical BP values but only with ABPM values (mean 24 h systolic r = 0.34, p <0.01; diastolic r = 0.37, p <0.01). The prevalence of LVH in patients controlled according to clinical BP criteria (n = 43, BP <140/90 mm Hg) was 19%, in patients controlled according to ABPM criteria (n = 30, BP during daytime <132/85 mm Hg) 17%, and in those controlled with both criteria (n = 16) 6% (p <0.01). Conclusions: The results of this study suggest that the eccentric type of LVH is the prevalent pattern in chronically treated patients. The persistence of LVH is significantly dependent on BP levels achieved during treatment; indeed the prevalence of LVH is very low in patients with an optimal BP control, whereas it is elevated (37%) in uncontrolled patients.

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          Most cited references 3

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          Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies.

          To determine the ability of various antihypertensive agents to reduce left ventricular hypertrophy, a strong, blood pressure-independent cardiovascular risk factor, in persons with essential hypertension. MEDLINE, DIMDI, RINGDOC, ADES, EMBASE, and review articles through July 1995 (English-language and full articles only). Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design. Intensive literature search and data extraction according to a prefixed scheme performed independently by 2 investigators. Reduction of left ventricular mass index after antihypertensive therapy with placebos, diuretics, beta-blockers, calcium channel blockers, or angiotensin-converting enzyme (ACE) inhibitors was the principal parameter. Of 471 identified references describing the effects of antihypertensive drugs on left ventricular hypertrophy, only 39 clinical trials fulfilled the inclusion criteria of our study. We found that the decrease in left ventricular mass index was more marked the greater was the decline in blood pressure (systolic r=0.46, P<.001; diastolic r=0.21, P=.08) and the longer was the duration of therapy (r=0.38, P<.01). After adjustment for different durations of treatment (mean duration of treatment, 25 weeks), left ventricular mass decreased 13% with ACE inhibitors, 9% with calcium channel blockers, 6% with beta-blockers, and 7% with diuretics. There was a significant difference between drug classes (P<.01): ACE inhibitors reduced left ventricular mass more than beta-blockers (significant, P<.05) and diuretics (tendency, P=.08). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<.05). The database of articles published through July 1995 is small and incomplete, and most of the articles are of poor scientific quality. In this first meta-analysis including only double-blind, randomized, controlled clinical studies, decline in blood pressure, duration of drug treatment, and drug class determined the reductions in left ventricular mass index. The ACE inhibitors seemed to be more potent than beta-blockers and diuretics in the reduction of left ventricular mass index; calcium channel blockers were somewhat in the intermediate range. The ACE inhibitors and, to a lesser extent, calcium channel blockers emerged as first-line candidates to reduce the risk associated with left ventricular hypertrophy.
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            The progression from hypertension to congestive heart failure

             D. Levy (1996)
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              Isolated office hypertension and end-organ damage

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2000
                August 2000
                14 August 2000
                : 93
                : 3
                : 149-154
                Affiliations
                aIstituto di Clinica Medica Generale e Terapia Medica, Ospedale Maggiore di Milano IRCCS, Centro di Fisiologia Clinica e Ipertensione e bOspedale San Luca IRCCS, Milano, Italia
                Article
                7019 Cardiology 2000;93:149–154
                10.1159/000007019
                10965085
                © 2000 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 5, References: 28, Pages: 6
                Categories
                General Cardiology

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