Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Abstract

BackgroundRegression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH.Methods and ResultsPatients from the Campania Salute Network, free of prevalent cardiovascular disease, but with echocardiographic LVH (defined as LV mass index [LVMi] >47 g/m2.7 in women and >50 g/m2.7 in men) were included. During a median follow‐up of 67 months, clear‐cut regression of LVH was documented in 14% of patients (13±8% reduction of initial LVMi) or 23% when also considering those with a reduction of LVMi ≥5 g/m2.7. Patients with persistent LVH were older with longer duration of hypertension, suboptimal blood pressure (BP) control, larger body mass index, LV mass, and carotid intima‐media thickness and included more women and subjects with diabetes mellitus, isolated systolic hypertension, and metabolic syndrome (all P<0.05). Number and class of antihypertensive drugs during follow‐up did not differ between groups. In multiple logistic regression analysis, older age, female sex, obesity, higher baseline LVMi and carotid intima‐media thickness, and suboptimal BP control were significant covariates of persistent LVH (all P≤0.01), independent of diabetes, duration of hypertension, isolated systolic hypertension, follow‐up time and number and class of antihypertensive drugs.ConclusionsEarly initiation of antihypertensive treatment, aggressive BP control, and attention to metabolic aspects are critical to avoid irreversible LVH.

Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

“…This finding is fitting with other observations from the SHS and other epidemiological studies [33–35], demonstrating disagreement between evolution of TOD and blood pressure.…”

Hypertension and left ventricular hypertrophy

“…At 4.7-year follow-up of 8,479 persons, mean age 67 years old, with hypertension and electrocardiographic LVH diagnosed by the Cornell criteria, less severe electrocardiographic LVH was associated with a 19% reduction in heart failure hospitalization for every 817-mm·msec lower Cornell product (20). In an outpatient clinic, at 67-month follow-up of patients with hypertension and echocardiographic LVH, regression of LVH occurred in 23% of patients treated with antihypertensive drugs (21).…”

“…Aggressive blood pressure control should be used to cause regression of LVH (21). A meta-analysis of 109 treatment studies including 2,357 patents with hypertension showed that angiotensinconverting enzyme inhibitors were the most effective antihypertensive drugs in reducing left ventricular mass (24).…”

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

“…Moreover, BP-lowering drugs were shown to reduce LV mass [71] and improve LV diastolic function [72] thus reversing two major cardiac consequences of hypertension. Studies investigating sex-specific effects of anti-hypertensive treatment on LVH came to discrepant and inconclusive findings so far [73][74][75][76]. As such, more research is required to elucidate a potential sex-dependent response of the heart to antihypertensive therapy, but optimal BP control appears to be an effective strategy to diminish subclinical maladaptation of the heart in both men and women.…”