Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

Abstract

L eft ventricular (LV) hypertrophy (LVH) is a marker of target organ damage in hypertension and helps stratifying cardiovascular risk.1,2 The effect of LVH on incident cardiovascular events is independent of conventional risk factors and of coronary artery disease. [3][4][5] In selected subsets of nondiabetic patients, LVH also precedes new onset of diabetes mellitus, 6 suggesting that hypertensive target organ damage might be also a marker of complex metabolic changes associated with the evolution of arterial hypertension.Prevention of the development of target organ damage should be, therefore, the main goal of management of arterial hypertension. 7,8 The most modifiable parameter to achieve this goal is the effective control of blood pressure (BP) using appropriate antihypertensive medications. There is no information on whether LVH could develop during antihypertensive regimen. However, we recently demonstrated that carotid plaque can develop in a specific patient phenotype, independently of optimal BP control. 10 In that study, we found that risk of incident carotid plaque was higher in older diabetic or smoker patients with chronic renal failure and higher initial intima-media thickness complex, suggesting that earlier antihypertensive management might be more beneficial to reduce and prevent target organ damage.In the present analysis, we evaluate whether LVH occurs during antihypertensive therapy and whether a specific phenotype can be identified at risk of incident LVH, in a large treated hypertensive population from a regional Italian registry. Methods Study PopulationHypertensive patients were selected from the Campania Salute Network (CSN) Registry. The CSN is an open registry collecting information from general practitioners and community hospitals networked with the Hypertension Research Center of the Federico Abstract-There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m 2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca ++ -channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients a...

2018 ESC/ESH Guidelines for the management of arterial hypertension

“…If, when, and how often the assessment of HMOD should be performed has not been validated in follow-up studies. HMOD can also develop during the course of antihypertensive treatment [185], and this may be accompanied by increased risk [186][187][188].…”

Insulin Resistance the Hinge Between Hypertension and Type 2 Diabetes

“…Development of LVH is a complex and multifactorial process which involves genetic, hemodynamic and anthropometric components, neuro-hormonal stimulation, growth factors and inflammatory mediators [53][54][55]. The hemodynamic and metabolic disorders associated with insulin resistance increase the risk LVH.…”

Prognostic Implications of Left Ventricular Hypertrophy

“…Another recent large study from Italy evaluated 4920 patients with treated HTN and no LVH at baseline, and found that baseline obesity status predicted development of incident LVH at 48 month follow up. 62 Following the myriad of known CV complications, smoking is also related with LVH. In the large MESA study mentioned previously, of 4,869 patients evaluated by CMR, current smokers had an average increase in LVM of 7.7g over non-smokers.…”