Gender Differences in Left Ventricular Structure and Function During Antihypertensive Treatment

Abstract

Abstract-In hypertensive patients with left ventricular hypertrophy, antihypertensive treatment induces changes in left ventricular structure and function. However, less is known about gender differences in this response. Baseline and annual echocardiograms until the end of study or a primary end point occurred were assessed in 863 hypertensive patients with electrocardiographic left ventricular hypertrophy aged 55 to 80 years (mean: 66 years) during 4. in women and men, respectively, and systolic function as ejection fraction and stress-corrected midwall fractional shortening. Women included more patients with obesity, isolated systolic hypertension, and mitral regurgitation (all PϽ0.01). Ejection fraction, stress-corrected midwall shortening, and prevalence of left ventricular hypertrophy were higher in women at baseline and at the end of study (all PϽ0.01). In particular, more women had residual eccentric hypertrophy (47% versus 32%; PϽ0.01) in spite of similar in-treatment reduction in mean blood pressure. In logistic regression, left ventricular hypertrophy at study end was more common in women (odds ratio: 1.61; 95% CI: 1.16 to 2.26; PϽ0.01) independent of other significant covariates. In linear regression analyses, female gender also predicted 2% higher mean in-treatment ejection fraction and 2% higher mean stress-corrected midwall shortening (both ␤ϭ0.07; PϽ0.01). Hypertensive women in this study retained higher left ventricular ejection fraction and stress-corrected midwall shortening in spite of less hypertrophy regression during long-term antihypertensive treatment. t is well documented that aggressive antihypertensive treatment reduces left ventricular (LV) mass and improves myocardial function in a majority of hypertensive patients with LV hypertrophy. Less LV hypertrophy reduction has been described in subgroups of patients, including patients with obesity, diabetes, or renal disease. 1-5 Several studies have reported gender differences in LV adaptation to chronic pressure overload in hypertension: women exhibit a greater prevalence of concentric LV geometry, as well as better indices of LV systolic chamber and myocardial function evaluated by echocardiography. 6 -8 Little is known about the impact of gender on changes in LV structure and systolic function during long-term antihypertensive treatment.Accordingly, the present analysis was undertaken to assess gender differences in LV structure and systolic function during 4.8 years of losartan-or atenolol-based antihypertensive therapy in hypertensive patients with electrocardiographic LV hypertrophy recruited in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. Methods Patient PopulationThe present analysis was carried out in the LIFE echocardiography substudy, which enrolled 960 of the 9193 participants in the parent trial for annual echocardiographic follow-up. 9,10 This analysis was not prespecified as part of the LIFE protocol but added to the data analysis plan before completion of the LIFE Stud...

Left Ventricular Mass Index: A Predictor of Morbidity and Mortality in Essential Hypertension

“…05). This finding is consistent with that reported by Gerdts et al 13 , who found a higher prevalence of increased left ventricular mass index in females (80%) as compared to males (70%). The duration of hypertension in patients with increased LVMI was found to be more than in patients with normal LVMI (p<0.…”

Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients

“…34,35 In the LIFE study at the end of follow-up, hypertensive women with initial electrocardiographic LVH exhibit residual LVH more often than men, despite aggressive antihypertensive therapy. 36 In the cohort of the Strong Heart Study, women exhibit greater LVMi than men, a difference substantially amplified by the copresence of obesity and independent of several confounders. 37 Not surprisingly, hypertensive women with LVH have an increased risk of incident heart failure with preserved ejection fraction, 38 and the reduction of risk parallels decrease in electrocardiographic LVH during antihypertensive treatment.…”

Sex determines cardiovascular hemodynamics in hypertension

“…However, several studies have reported better LV function evaluated by echocardiography in hypertensive women than in men. [19][20][21][22] Already 25 years ago Garavaglia et al 22 observed better echocardiographic left ventricular indices in females (including left ventricular ejection fraction and velocity of circumferential fiber shortening), but those differences tended to disappear after menopause. Gerdts et al 20 revealed higher left ventricular ejection fraction, endocardial and midwall fractional shortening and lower end-systolic wall stress in hypertensive women with LVH.…”