Left ventricular hypertrophy as a predictor of cardiovascular risk

Abstract

Left ventricular hypertrophy (LVH) is a potent, independent predictor of cardiovascular events, particularly in hypertension, in which it dramatically increases the risk of stroke, coronary heart disease and heart failure. LVH is predominantly a surrogate marker for the effects of other risk factors integrated over time, but it may also contribute directly to cardiovascular disease through pathological changes in cardiac structure. The influence of blood pressure is central to LVH pathology, with 24-h blood pressure being more predictive of LVH than single clinic measurements. Blood pressure variation throughout the day is also emerging as an important correlate of LVH, and a strong association has been found between the early morning blood pressure rise and increased left ventricular mass. Antihypertensive treatment can reverse LVH, and preliminary studies suggest that this improves cardiovascular outcome and long-term prognosis. Most classes of antihypertensive agent show some effect on LVH regression, with the notable exceptions of minoxidil and hydralazine. However, many of the data regarding LVH regression come from small, poor-quality trials or from meta-analyses of these studies. In the few well-conducted studies that are available, certain classes of antihypertensive drugs are more effective than others. Those that target angiotensin II, such as the angiotensin II receptor blockers, appear to have a specific action on LVH that is independent of blood pressure reduction. Further high-quality studies are needed to define how LVH predicts cardiovascular risk, which agents are most effective at eliciting LVH regression and how such reversal can affect cardiovascular outcome. J Hypertens 23 (suppl 1):S27-S33 Q 2005 Lippincott Williams & Wilkins. Journal of Hypertension 2005, 23 (suppl 1):S27-S33

Renal resistive index and cardiovascular organ damage in a large population of hypertensive patients

“…26 A direct correlation between IMT, LVMI and the risk of myocardial infarction and stroke in a population of patients without a prior history of CV disease has been shown. [27][28] We report that the highest RRI levels are associated with other forms of CV organ damage. Our results suggest that the RI of intrarenal arteries could be a useful marker for early organ damage and might be a predictor of future CV complications in hypertensive patients.…”

Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies

“…Hence, any potential BP-independent benefits attributable to the angiotensin mechanism (19)(20)(21)(22) uniformly applied to both the CCB and HCTZ groups. The relative effects of specific antihypertensive medications used on the cardiac parameters measured require a larger sample of subjects.…”

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

“…[10][11][12][13][14] Reduction in LVH by antihypertensive treatment is associated with improved outcome and decreased risk of cardiovascular morbidity and mortality. [10][11][12] However, the link between elevated BP and LVH in children with CKD remains controversial.…”