Effect of Single-Drug Therapy on Reduction of Left Ventricular Mass in Mild to Moderate Hypertension

Gottdiener, John S.; Reda, Domenic J.; Massie, Barry M.; Materson, Barry J.; Williams, David Wynne

doi:10.1161/01.cir.95.8.2007

Cited by 262 publications

(91 citation statements)

References 26 publications

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“…Failing to identify LAE may alter an individual's cardiovascular risk estimation and theoretically could have treatment implications (1). Furthermore, in subgroup analysis of the LIFE study, Wachtell et al found that prevention of AF during antihypertensive treatment may be improved by antihypertensive therapy that reduces LA size in addition to controlling blood pressure (34) and the effect of different antihypertensive agents on LA size has been previously been investigated (35).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

et al. 2016

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Left atrial enlargement (LAE) has adverse prognostic implications in hypertension.We sought to determine the accuracy of 5 ECG criteria for LAE in hypertension relative to cardiac magnetic resonance (CMR) gold-standard, and investigate the effect of concomitant obesity. 130 consecutive patients (age: 51.4 ± 15.1 years, 47% male, 51% obese, systolic blood pressure: 171 ± 29mmHg, diastolic blood pressure: 97 ± 15mmHg) referred for CMR (1.5T) from a tertiary hypertension clinic were included. Patients with concomitant cardiac pathology were excluded. ECGs were assessed blindly for: 1) P wave >110ms, 2) P mitrale, 3) P wave axis <30°, 4) Area of negative P terminal force in V1 >40ms·mm and 5) Positive P terminal force in aVL >0.5mm. LA volume ≥55ml/m 2 , measured blindly by CMR, was defined as LAE.Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the receiver operator curve were calculated. The prevalence of LAE by CMR was 26%. All the individual ECG LAE criteria were more specific than sensitive, with specificities ranging from 70% (P axis <30 o ) to 99% (P mitrale). Obesity attenuated the specificity of most of the individual ECG LAE criteria. Obesity correlated with significant lower specificity (48% vs 65%, P < 0.05) and a trend towards lower sensitivity (59% vs 43%, P = 0.119) when ≥1 ECG LAE criteria were present. Individual ECG criteria of LAE in hypertension are specific, but not sensitive, at identifying LAE. The ECG should not be used to excluded LAE in hypertension, particularly in obese subjects.

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

et al. 2016

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“…Our study is the first to demonstrate that sex also influences regression of LV hypertrophy in a large sample of hypertensive patients with a high prevalence of LV hypertrophy at baseline who were treated in a systematic fashion by structured, blinded drug regimens. After adjustment for the important effects of baseline LV mass 11 and randomized study treatment, 14 LIFE women had greater reductions in LV mass than LIFE men after 12 months, by 8.0 g (about 6% more).…”

Section: Discussionmentioning

confidence: 95%

“…[7][8][9] Several studies have shown that most antihypertensive medications can regress LV hypertrophy, though perhaps with varying efficacy. [10][11][12] However, it remains unclear whether regression of LV hypertrophy differs between sexes. Thus, the present study was undertaken to determine whether sexrelated differences in LV mass regression exist in the participants of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study after 12 months of sustained antihypertensive treatment.…”

Section: Introductionmentioning

confidence: 99%

Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

et al. 2004

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While left ventricular (LV) structure and function differ between hypertensive women and men, it remains unclear whether sex affects regression of LV hypertrophy with antihypertensive treatment. We analysed paired echocardiograms in 500 men and 347 women enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study at baseline and after 12 months of antihypertensive treatment with either losartan or atenolol. At enrolment, 177 women and 242 men were randomized to losartan-based treatment and 161 women and 247 men were randomized to atenolol-based treatment (sex difference ¼ NS). After 12 months of antihypertensive treatment, blood pressure was lowered similarly in women (152/83 from 174/97 mmHg) and men (149/85 from 173/99 mmHg; both Po0.001, sex difference ¼ NS), without significant change in body weight in either sex. Cardiac output and pulse pressure/stroke volume were equivalently reduced in both sexes (À0.2 vs À0.1 l/min and both -0.20 mmHg/ml/m 2 , respectively; both P ¼ NS). Absolute LV mass change after 12 months of antihypertensive treatment was greater in men than in women (À30 vs À24 g, P ¼ 0.01). However, after adjusting for baseline LV mass and randomized study treatment, LV mass reduction was greater in women than in men (À33 vs À23 g, P ¼ 0.001). LV mass regression was greater in women, by 8.072.8 g, after adjusting for baseline LV mass and randomized study treatment. After consideration of baseline LV mass and randomized study treatment, antihypertensive treatment regressed LV hypertrophy more in women. Further studies are needed to identify the mechanisms and prognostic implications of this sex-related difference.

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“…9,10 Angiotensin-converting enzyme (ACE) inhibitors, ␤-blockers, and calcium channel blockers have dem-onstrated their ability to promote LVH regression. 11,12 However, due to many limitations related to methodology (small number of patients, short treatment duration, non-comparative design and unblinded echocardiogram analysis) these studies have yielded no definite conclusions on the comparative efficacy of treatments in LVH regression. Four meta-analysis 13 suggest a higher effectiveness of ACE inhibitors over ␤-blockers, diuretics, or calcium antagonists in reducing LV mass (LVM) [14][15][16][17] but according to the lack of sufficiently powered comparative trials and publication bias their results must be taken with due caution.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of very low dose perindopril 2 mg/indapamide 0.625 mg combination on left ventricular hypertrophy in hypertensive patients: the P.I.C.X.E.L. study rationale and design

et al. 2002

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The PICXEL study is designed to evaluate the effects of long-term administration of very low-dose combination perindopril 2 mg/indapamide 0.625 mg (Per/Ind) vs enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. This multicentre, controlled, randomised, double-blind, parallel group study is carriedout to assess the variation of left ventricular mass index (LVMI) after treatment, using a centralised control of Mmode echocardiography determinations, and a dedicated software for semi-automatic measurement. Following a 4-week placebo run-in period, hypertensive outpatients aged у18 years, with LVH (LVMI Ͼ120 and 100 g/m 2 for men and women, respectively), are randomised to receive once daily, over 52 weeks, either Per/Ind or enalapril. According to blood pressure levels, the dose may be adjusted. In addition to clinical examinations, ECG, blood pressure, heart rate and laboratory assessments echocardiographic determinations are performed for selection, at baseline, after 24 weeks and

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Effect of Single-Drug Therapy on Reduction of Left Ventricular Mass in Mild to Moderate Hypertension

Cited by 262 publications

References 26 publications

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

Efficacy of very low dose perindopril 2 mg/indapamide 0.625 mg combination on left ventricular hypertrophy in hypertensive patients: the P.I.C.X.E.L. study rationale and design

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