Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study

Verdecchia, Paolo; Carini, G; Circo, A; Dovellini, Emilio Vincenzo; Giovannini, E; Lombardo, Michele; Solinas, Pasquale; Gorini, Marco; Maggioni, Aldo P.

doi:10.1016/s0735-1097(01)01663-1

Cited by 335 publications

(221 citation statements)

References 29 publications

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“…The limit of statistical significance was set at Po0.05 by two-tailed tests. 16,17,23,29,40 3 interventional prospective trials 13,30,34 and the remaining 2 were performed in specialist out-patient centers. 19,42 In approximately half of the studies, the effective observation period, including the echocardiographic examination, was before the year 2000.…”

Section: Discussionmentioning

confidence: 99%

“…14,15,17,19,21,24 --26,28,36 In contrast, LVH ranged from 43.6 to 52.8% (P ¼ 0.03 for comparison between more sensitive criteria) in the four studies (n ¼ 6427) with the highest proportion of patients on antihypertensive treatment (X85%). 16,29,35,40 Table 3 shows the findings of 13 studies (n ¼ 16 033 patients) providing LVH rates according to a gender-based analysis. 13,14,17,21,22,24,28,30 --32,36,38,40 In 8 out of 12 studies, LVH prevalence was higher in women; in 2 reports the trend was opposite and in the remaining 3 LVH was more prevalent in men according to some but not all criteria.…”

Section: Prevalence Of Lvhmentioning

confidence: 99%

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Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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on behalf of the Italian Society of Hypertension Left-ventricular hypertrophy (LVH) is a cardinal manifestation of hypertensive organ damage associated with an increased cardiovascular (CV) risk. We reviewed recent literature on the prevalence of LVH, as assessed by echocardiography, in order to offer an updated information on the magnitude of subclinical alterations in LV structure in contemporary human hypertension. A MEDLINE search using key words 'left ventricular hypertrophy', 'hypertension', 'echocardiography' and 'cardiac organ damage' was performed in order to identify relevant papers. Full articles published in English language in the last decade, (1 January 2000 --1 December 2010), reporting studies in adult or elderly individuals, were considered. A total of 30 studies, including 37 700 untreated and treated patients (80.3% Caucasian, 52.4% men, 9.6% diabetics, 2.6% with CV disease) were considered. LVH was defined by 23 criteria; its prevalence ranged from 36% (conservative criteria) to 41% (less conservative criteria) in the pooled population. LVH prevalence was not different between women and men (range 37.9 --46.2 versus 36.0 --43.5%, respectively). Eccentric LVH was more frequent than concentric hypertrophy (range 20.3 --23.0 versus 14.8 --15.8, respectively, Po0.05); concentric phenotype was found in a consistent fraction (20%) of both genders. Despite the improved management of hypertension in the last two decades, LVH remains a highly frequent biomarker of cardiac damage in the hypertensive population. Our analysis calls for a more aggressive treatment of hypertension and related CV risk factors leading to LVH. INTRODUCTIONLeft ventricular hypertrophy (LVH) secondary to arterial hypertension is a complex cardiac phenotype resulting from the response of myocyte and non-myocyte components to mechanical and neuro-humoral stimuli. 1 Although the mechanisms underlying this process remain incompletely understood, available evidence from the last two decades indicates that chronic haemodynamic overload has a driving role in activating LV myocardial growth; in turn, non-haemodynamic variables (that is, genetic, ethnic, environmental and hormonal factors) modulate the extent (and type) of the hypertrophic response. 2 --4 LVH in hypertensive patients may be regarded as a powerful, independent biomarker reflecting the impact of pressure overload as well as of several risk factors 5 on the heart.Routinely assessed LVH by electrocardiography or more accurately by echocardiography, is a strong determinant of cardiovascular (CV) prognosis over and beyond conventional risk factors in both population-based studies and in selected hypertensive cohorts. 6 --8 Initial levels of LV mass and mass reduction during antihypertensive treatment define CV risk related to subclinical cardiac damage 9 and influence therapeutic strategies. 10 In recent years, observational and interventional studies addressing hypertensive LVH performed worldwide 5 --9,11,12 offered us the opportunity to update available information o...

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Section: Discussionmentioning

confidence: 99%

Section: Prevalence Of Lvhmentioning

confidence: 99%

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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“…LVH can adversely impact on the quality of life and heralds increased risk of cardiovascular morbidity and mortality. 2 However, a recently published meta-analysis showed that not all classes of antihypertensive drugs are equally effective in reversing LVH. 19 In the present study, ABPM showed that telmisartan significantly lowered 24-h mean SBP and DBP.…”

Section: Discussionmentioning

confidence: 99%

“…1 Therefore, left ventricular hypertrophy (LVH) regression is a key objective when managing hypertensive patients, the risk of cardiovascular disease being reduced in patients with LVH regression compared with those with none. 2 According to a meta-analysis published in 1992, 3 ACE inhibitors produced the greatest reduction in LVM, despite the blood pressure reductions produced by other classes of antihypertensive agents F beta-blockers, calcium channel blockers and diuretics F being equivalent to those of ACE inhibitors. As a class, ACE inhibitors are well recognised as being effective in the treatment of hypertension and relatively well tolerated.…”

Section: Introductionmentioning

confidence: 99%

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

et al. 2003

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Antihypertensive efficacy, effects on left ventricular mass index (LVMI) and tolerability of telmisartan, an angiotensin II receptor blocker, were compared with those of hydrochlorothiazide (HCTZ). Adult patients with mild-to-moderate hypertension and an optimal acoustic window by two-dimensional echocardiography were randomised at baseline to 12 months' double-blind, once-daily treatment with telmisartan 80 mg or HCTZ 25 mg. Two-dimensional echocardiography and freehand precordial three-dimensional echocardiography and 24-h ambulatory blood pressure monitoring were performed at baseline and after treatment. Of the 41 telmisartan group patients and 28 HCTZ group patients, 40 and 25, respectively, completed the study. Following treatment, 24-h mean SBP (telmisartan 157 7 11 vs 133 7 7 mmHg, Po0.001; HCTZ 154 7 10 vs 144 7 11 mmHg, Po0.003) and DBP (telmisartan 96 7 6 vs 83 7 5 mmHg, Po0.001; HCTZ 95 7 7 vs 87 7 8 mmHg, Po0.003) were significantly reduced. Telmisartan produced significantly greater 24-h mean SBP and DBP reductions than HCTZ (Po0.001). LVMI was significantly reduced by telmisartan (141 7 16 vs 125 7 19 g/m 2 , Po0.001), but not by HCTZ (139 7 20 vs 135 7 22 g/m 2 ). Incidences of adverse events in both the treatment groups were low; two cases of hypokalaemia occurred with HCTZ. In conclusion, telmisartan 80 mg was well tolerated and significantly reduced SBP, DBP and LVMI after 12 months' treatment compared with HCTZ.

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“…[7][8][9][10][11] The presence of LVH, in turn, constitutes an important independent factor for cardiovascular risk in patients with CKD. 7,8,12,13 Patients in renal replacement therapy (stage V) 6 may have larger or smaller residual renal function (RRF) declines depending on the diastolic method used. 14 Thus, patients on hemodialysis (HD) had more rapid reductions in their RRF than those on peritoneal dialysis (PD).…”

Section: Introductionmentioning

confidence: 99%

Morfologia e função cardíacas em pacientes renais crônicos, com ou sem diurese residual, em tratamento hemodialítico

Araújo¹,

Lemes²,

Cunha³

et al. 2011

J. Bras. Nefrol.

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In patients with chronic renal failure on hemodialysis, left ventricular hypertrophy is related to the increase in total peripheral vascular resistance and volume overload. The presence of residual diuresis enables greater control of the volemia of these. We evaluated the morpho-functional changes of the left ventricle in patients with chronic kidney disease on hemodyalisis treatment with and without residual diuresis. A total of 31 non diabetic patients were studied and they were divided into two groups: with residual diuresis (RD+) (n = 17) and without residual diuresis (RD-) (n = 14). In both groups, RD+ vs. RD-, using data from a Doppler echocardiogram differences were found, respectively, in the cardiac index (3.9 ± 0.2 vs. 3.0 ± 0.2 L/min/m 2 ; p = 0.0056), systolic index (54 ± 2.9 vs. 45 ± 3.3 mL/b/m 2 ; p = 0.04), end diastolic volume (141 ± 6.7 vs. 112 ± 7.6 mL; p = 0.008), end diastolic diameter (52 ± 0.7 vs. 48 ± 1.1 mm; p = 0.0072) and total peripheral resistance index (1121 ± 56 vs. 1529 ± 111 dyne.sec.cm -5 ; p = 0.001). RD+ had lower relative wall thickness than RD-(0.38 ± 0.01 vs. 0.45 ± 0.01; p = 0.0008). The ejection fraction and the left ventricular mass index were similar in both groups. The urinary 24-hour volume correlated with the relative wall thickness (r = -0.42; p = 0.0186) and with peripheral resistance index (r = -0.48; p = 0.0059). In conclusion, there were distinct ventricular geometric patterns and different functional performances between RD+ and RD-groups. The presence of residual diuresis can be responsible by these modifications in systolic function.

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Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study

Abstract: Our findings show a strong, continuous and independent relationship of LV mass to subsequent cardiovascular morbidity. This is the first study to extend such demonstration to a large nationwide multicenter sample of uncomplicated subjects with essential hypertension.

Cited by 335 publications

References 29 publications

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Freehand three-dimensional echocardiographic evaluation of the effect of telmisartan compared with hydrochlorothiazide on left ventricular mass in hypertensive patients with mild-to-moderate hypertension: a multicentre study

Morfologia e função cardíacas em pacientes renais crônicos, com ou sem diurese residual, em tratamento hemodialítico

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