Left ventricular hypertrophy: reduction of blood pressure already in the normal range further regresses left ventricular mass

Simpson, Helen; Gandy, Stephen J.; Houston, J. Graeme; Rajendra, N. S.; Davies, Justine; Struthers, Allan D.

doi:10.1136/hrt.2009.177238

Cited by 34 publications

(27 citation statements)

References 32 publications

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“…Similarly, although the study was only of 6-month duration, reductions in blood pressure in previous studies have been seen within a few weeks of large oral doses of vitamin D. Reduction in LV mass on MRI has been demonstrated within 9 months with other vascular interventions, for instance by previous studies on allopurinol and on blood pressure reduction. 21,22 However, our results are consistent with the main findings of the PRIMO (Paricalcitol Capsule Benefits in Renal FailureInduced Cardiac Morbidity) trial, which showed no effect of 48 weeks of paricalcitol therapy on LV mass in patients with advanced kidney disease. 14 Changes in left atrial volume may provide a more sensitive early measure of cardiac remodeling, and a substudy of PRIMO did find a reduction in left atrial volume with paricalcitol therapy 23 ; we were unable to demonstrate this in the current study although the number of patients with usable left atrial volumetric information was low.…”

Section: Discussionsupporting

confidence: 82%

Vitamin D Therapy to Reduce Blood Pressure and Left Ventricular Hypertrophy in Resistant Hypertension

et al. 2014

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R esistant hypertension, defined as an office systolic blood pressure of >140 mm Hg or diastolic blood pressure of >90 mm Hg, despite maximally tolerated treatment with ≥3 antihypertensive agents, affects 10% to 30% of patients with hypertension.1 Resistance to treatment is associated with a high incidence of cardiovascular events.2 Resistant hypertension is also associated with a high incidence of left ventricular (LV) hypertrophy, 3 itself a risk factor for cardiovascular events, arrhythmias, and death. 4 Relatively few studies target resistant hypertensive patients as a discrete subgroup, and treatment algorithms are not as well defined for this group of patients as for those with more straightforward mild to moderate hypertension. Despite a wide range of antihypertensive agents now being available with multiple modes of action, treatment of resistant hypertension remains problematic, with many patients experiencing treatment-limiting side effect. 5 Although recent interest has focused on invasive solutions, such as renal denervation therapy, 6 the large burden of resistant hypertension at the population level means that inexpensive, easily applied interventions to mitigate the problem are still required.Low vitamin D levels are associated with higher blood pressure 7 and a higher rate of both incident hypertension 8 and cardiovascular disease 9,10 in observational studies. Previous intervention trials 11 have suggested that vitamin D may reduce blood pressure in selected groups of patients with hypertension; however, no trials to date have evaluated the effects of vitamin D on resistant hypertension. Pathophysiological investigation suggests a link between low vitamin D levels and LV hypertrophy, possibly mediated by parathyroid hormone, 12,13 but few studies have examined the effect of vitamin D analogues on LV mass. 14,15Therefore, we conducted a randomized controlled trial to test the effect of intermittent high-dose vitamin D on See Editorial Commentary, pp 672-674Abstract-Low 25-hydroxyvitamin D levels are associated with higher prevalent blood pressure. We tested whether high-dose intermittent oral vitamin D therapy could reduce blood pressure and left ventricular mass in patients with hypertension resistant to conventional treatment. We conducted a parallel-group, double-blind, randomized placebo-controlled trial.Patients with supine office blood pressure >140/90 mm Hg on ≥3 antihypertensive agents received 100 000 U oral vitamin D3 or matching placebo every 2 months. Office and 24-hour ambulatory blood pressure, glucose, and cholesterol were measured at baseline, 2, 4, and 6 months; left ventricular mass index was measured by cardiac MRI on a subgroup at baseline and 6 months. The primary outcome was mean 24-hour ambulatory blood pressure at 6 months. A total of 68 participants were randomized, 34 in each group. Mean age was 63 (SD 11) years, mean baseline office blood pressure was 154/84 (13/10) mm Hg, and mean baseline 25-hydroxyvitamin D level was 42 (16)

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Section: Discussionsupporting

confidence: 82%

Vitamin D Therapy to Reduce Blood Pressure and Left Ventricular Hypertrophy in Resistant Hypertension

et al. 2014

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“…Более того, было продемонстрировано снижение массы миокарда у пациентов с ГЛЖ даже в отсутствии повышенного давления [17]. Одним из немногочисленных исследований в области эво-люции раннего ПОМ у пациентов с метаболическими нарушениями является работа Gomez-Marcos с соав-торами, которые зарегистрировали повышение элек-трографических признаков ГЛЖ, а также снижение ЛПИ и СРПВ.…”

Section: Discussionunclassified

Association of the Metabolic Syndrome Constituents With Markers of Subclinical Target Organ Damage During Follow-Up of Intellectual Laborers

Rotar¹,

Бояринова²,

Могучая³

et al. 2015

Ross. kardiol. ž.

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Цель. Оценить связь метаболического синдрома (МС) и его компонентов с мар-керами субклинического поражения органов-мишеней (ПОМ) при динамиче-ском наблюдении относительно здоровых работников умственного труда. Материал и методы. Из выборки 1600 обследованных работников банка были отобраны случайным образом 383 участников с хотя бы одним компонен-том МС без сердечно-сосудистых заболеваний, из которых на повторное исследование через 2 года пришли 331 пациент (отклик 86%). Средний воз-раст участников 46,6±9,0 лет, среди которых преобладали женщины (214 (64,6%)). Всем пациентам проводилась антропометрия, измерение артери-ального давления (АД), исследование липидов, креатинина и глюкозы нато-щак, эхокардиография с оценкой показателей гипертрофии левого желудочка (ГЛЖ), ультразвуковое исследование сонных артерий (оценка комплекса интима-медиа (КИМ) и атеросклеротических бляшек), оценка сосудистой жесткости, лодыжечно-плечевого индекса, концентрации альбумина в разо-вой порции мочи на обоих этапах наблюдения. Результаты. При проведении множественной логистической регрессии нали-чие артериальной гипертензии (АГ) ассоциировалось с повышенной вероят-ностью ГЛЖ, утолщения КИМ и повышенной сосудистой жесткости при стан-дартизации на пол и возраст. Связи МС с маркерами ПОМ выявлено не было. Через 2 года наблюдения отмечается значимое нарастание количества паци-ентов с утолщением КИМ (с 81 (24,5%) до 146 пациентов (44,1%), p<0,001) и снижение распространенности ГЛЖ (с 154 (46,7%) до 109 (32,9%), р=0,003) на фоне значимого снижения уровня АД и общего холестерина в динамике. Заключение. Наличие АГ ассоциировано с повышенной вероятностью нали-чия ГЛЖ и повышенной жесткости сосудов, а также атеросклеротических изменений сонных артерий. МС не был связан с вероятностью наличия ПОМ, основными определяющими факторами структурных изменений сердца, сосу-дов и почек были АГ, пол и возраст. За 2 года наблюдения отмечено значимое снижение количества пациентов с ГЛЖ и дисфункцией почек на фоне улучше-ния профиля АД, а также увеличение количества пациентов с утолщением КИМ, несмотря на уменьшение количества пациентов с гиперхолестерине-мией. У пациентов с МС за время наблюдения чаще назначалась антигипер-тензивная терапия, что сопровождалось более значимым регрессом ГЛЖ. ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERSRotar O. P., Boyarinova М. А., Moguchaya Е. V., Kolesova Е. P., Erina А. М., Solntsev V. N., Konradi А. О. Aim.To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers. Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure meas...

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“…26 In meta-analysis, the absolute reductions in LV mass were 22.8 gm with β-blockers with similar figures for calcium antagonists and diuretics, although ACEIs were twice as potent. 27 Further regression of LVH in such normotensive patients is likely to reduce future cardiovascular events.…”

Section: Treatment Of Residual Risk: Lvhmentioning

confidence: 99%

High B-Type Natriuretic Peptide Hypertensives at Target Blood Pressure

Struthers

George

2015

Hypertension

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Left ventricular hypertrophy: reduction of blood pressure already in the normal range further regresses left ventricular mass

Abstract: ISRCTN48331653.

Cited by 34 publications

References 32 publications

Vitamin D Therapy to Reduce Blood Pressure and Left Ventricular Hypertrophy in Resistant Hypertension

Vitamin D Therapy to Reduce Blood Pressure and Left Ventricular Hypertrophy in Resistant Hypertension

Association of the Metabolic Syndrome Constituents With Markers of Subclinical Target Organ Damage During Follow-Up of Intellectual Laborers

High B-Type Natriuretic Peptide Hypertensives at Target Blood Pressure

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