Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension

Soliman, Elsayed Z.; Ambrosius, Walter T.; Cushman, William C.; Zhang, Zhu Ming; Bates, Jeffrey T.; Neyra, Javier A.; Carson, Thaddeus Y; Tamariz, Leonardo; Ghazi, Lama; Cho, Monique E.; Shapiro, Brian P.; He, Jiang; Fine, Lawrence J.; Lewis, Cora E.

doi:10.1161/circulationaha.117.028441

Cited by 131 publications

(80 citation statements)

References 53 publications

(42 reference statements)

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“…However, the significantly increased risks of cardiovascular death, stroke, and LIFE study composite end point in patients with persistent LVH by CP criteria despite having average on‐treatment systolic BP ≤130 mm Hg raises the possibility that additional BP lowering in patients who do not adequately regress LVH may not improve prognosis. In contrast, Soliman et al demonstrated that more intensive BP reduction was associated with greater LVH regression and lower rates of developing new LVH among patients with hypertension and diabetes mellitus in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study and patients with diabetes mellitus in SPRINT (Systolic Blood Pressure Intervention Trial), but that the greater LVH regression in SPRINT did not appear to explain most of the reduction in cardiovascular events. Further study will be required to evaluate whether specifically targeting patients with persistent LVH to further reduce BP and produce regression of LVH can improve prognosis in this high‐risk subgroup of patients with hypertension.…”

Section: Discussionmentioning

confidence: 92%

Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension

Okin

Hille

Kjeldsen

et al. 2017

JAHA

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BackgroundPatients with hypertension with ECG left ventricular hypertrophy (LVH) have higher cardiovascular morbidity and mortality, but single ECG criteria may underestimate risk. Whether continued presence or new development of ECG LVH by 2 criteria can further concentrate risk during blood pressure lowering is unclear.Methods and ResultsIncident stroke, myocardial infarction, cardiovascular death, the composite of these outcomes, and all‐cause mortality were examined in relation to the presence of on‐treatment ECG LVH by Cornell product and/or Sokolow‐Lyon voltage during a mean of 4.8±0.9 years follow‐up in 9193 patients with hypertension randomized to losartan‐ or atenolol‐based regimens. Patients were categorized into 4 groups according to the presence or absence of ECG LVH by each criterion at baseline and yearly during the study. At baseline, LVH by both criteria was present in 960 patients (10.4%). Compared with the absence of ECG LVH by both criteria, persistence or development of ECG LVH by both criteria entered as a time‐varying covariate was associated with >3‐fold increased risks of events in multivariable Cox analyses adjusting for randomized treatment, baseline risk factors, and on‐treatment heart rate and systolic and diastolic blood pressures. Patients with ECG LVH by either Cornell product or Sokolow‐Lyon voltage had 45% to 140% higher risks of all end points.ConclusionsPersistence or development of ECG LVH by both Cornell product and Sokolow‐Lyon voltage criteria during antihypertensive therapy is associated with markedly increased risks of cardiovascular end points and all‐cause mortality. Further study is indicated to determine whether additional therapy in these patients can reduce their risk.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.

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Section: Discussionmentioning

confidence: 92%

Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension

Okin

Hille

Kjeldsen

et al. 2017

JAHA

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“…Given the lower sensitivity of ECG and the added complexity and cost of broad application of echocardiography, the exact adjunctive role of detection and assessment of LVH in refining cardiovascular risk prediction thus remains unclear. Matters are further complicated by the difficulties in predicting which individual patients would benefit the most from antihypertensive therapy, 38,39 and by extension, which patients, particularly among those without any electrocardiographic abnormalities, would be most likely to benefit from echocardiographic assessment 6,40,41 . Further studies are required to determine whether an increased use of echocardiography, or potentially rapid point‐of‐care ultrasound, may improve contemporary risk stratification and inform treatment decisions for hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular hypertrophy (LVH) is a well‐known risk factor for cardiovascular morbidity and mortality 1‐3 . Early diagnosis is essential as regression of LVH is associated with a reduction in cardiovascular events 4‐6 . Although several modalities are available for detection of LVH, ECG and echocardiography are most commonly used in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Prognostic implications of left ventricular hypertrophy diagnosed on electrocardiogram vs echocardiography

Pedersen

Kristensen

Petersen

et al. 2020

J of Clinical Hypertension

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It is unclear whether 12-lead ECG employing standard criteria for left ventricular hypertrophy (LVH) provides similar information with respect to long-term cardiovascular risk as echocardiography. The authors performed a retrospective cohort study of 1376 individuals without cardiovascular disease, who underwent ECG (LVH defined using the Sokolow-Lyon voltage combination (>35 mm) or the Cornell voltage-duration product (>2440 mm × ms)) and echocardiography (LVH defined as LV mass index (LVMI) >95 g/m 2 for women and >115 g/m 2 for men). The prognostic ability of LVH was assessed in Cox regression models adjusted for age, sex, smoking, systolic blood pressure, total cholesterol, antihypertensive medication, and fasting glucose. The primary end point was the composite of coronary events, heart failure, stroke, or death. The main secondary end point was heart failure or cardiovascular death. Median age was 67 (range 56-79) years, 68% were male. Eleven percent had ECG-defined LVH, 17% had echocardiographic LVH. Over median 8.5 years, 29% experienced a primary event. Event rates were 29%/35% for persons without/with ECG-defined LVH and 27%/39% for those without/with echocardiographic LVH. The Sokolow-Lyon combination, Cornell product, and ECG-defined LVH did not significantly predict the primary end point (P ≥ .05), but ECG-defined LVH predicted heart failure or cardiovascular death (adjusted hazard ratio (HR), 1.86, 95% confidence interval (CI), 1.13-3.08); P = .02). Conversely, LVMI was a significant, independent predictor of the primary end point (adjusted HR, 1.87, 95% CI, 1.13-3.10; P = .01), as was echocardiographic LVH (adjusted HR, 1.27, 95% CI, 1.01-1.61; P = .04). Echocardiographic LVH may be a better predictor of long-term cardiovascular risk than ECG-defined LVH in middle-aged and older individuals. 1648 | PEDERSEN Et al. 1 | INTRODUC TI ON Left ventricular hypertrophy (LVH) is a well-known risk factor for cardiovascular morbidity and mortality. 1-3 Early diagnosis is essential as regression of LVH is associated with a reduction in cardiovascular events. 4-6 Although several modalities are available for detection of LVH, ECG and echocardiography are most commonly used in daily clinical practice. ECG is easy to perform, but its specificity and, in particular, sensitivity are limited. On the other hand, echocardiography has a higher diagnostic accuracy, but is more expensive and time-consuming. 7-10 Contemporary guidelines for arterial hypertension and appropriate use criteria for echocardiography do not support universal application of echocardiography in patients with hypertension, but recommend its use when the results are likely to influence management. 10-12 However, it is unclear whether 12-lead ECG employing standard criteria for LVH provides similar information with respect to long-term cardiovascular risk as echocardiography. Data on direct prognostic comparisons remain scarce, though some studies have suggested potential advantages of echocardiography compared with ECG depending on the setting. 13-...

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“…Fortunately, antihypertensive treatment can reduce LVH in both children ( 75 , 76 ) and adults ( 77 – 81 ) where regression in LVH is independently associated with improved CV outcomes ( 82 ). For patients with increased LVM, we typically re-assess LVM on an annual basis until normalization of LVM is noted.…”

Section: Non-invasive Assessments Of Cardiac and Vascular Target Orgamentioning

confidence: 99%

Cardiac and Vascular Target Organ Damage in Pediatric Hypertension

Khoury

Urbina

2018

Front. Pediatr.

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Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.

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Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension

Cited by 131 publications

References 53 publications

Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension

Combining ECG Criteria for Left Ventricular Hypertrophy Improves Risk Prediction in Patients With Hypertension

Prognostic implications of left ventricular hypertrophy diagnosed on electrocardiogram vs echocardiography

Cardiac and Vascular Target Organ Damage in Pediatric Hypertension

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