Prevalence of Left Ventricular Hypertrophy in Hypertensive Patients Without and With Blood Pressure Control

Mancia, Giuseppe; Carugo, Stefano; Grassı, Guıdo; Lanzarotti, Arturo; Schiavina, Riccardo; Cesana, Giancarlo; Sega, Roberto

doi:10.1161/hy0302.104669

Cited by 106 publications

(62 citation statements)

References 31 publications

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“…In our series, LVH prevalence was consistently higher than that found in studies conducted in population-based samples and in untreated hypertensives attending at specialist centres. 29,30 Our values, however, are in line with that reported (70%) in a large Spanish survey of 946 essential hypertensives from primary care centres. 31 Several factors may explain the high prevalence of LVH in our survey: (1) old age (less than 7% of our patients were o40 years); (2) duration of hypertension (less than 20% were untreated, that is, in the initial phase); moreover, up to 50% of patients had a previous echo examination and was reassessed for LVH regression; (3) non-standardized identification of LV interfaces due to the lack of a reading centre.…”

Section: Echocardiography In Hypertension C Cuspidi Et Alsupporting

confidence: 92%

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

et al. 2009

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Little information is available about the burden of hypertension on echo-lab activity in current practice. The aim of the present nation-wide survey in outpatient echo-labs was to investigate the prevalence rates of (1) echo examinations performed for the evaluation of hypertensive cardiac damage; (2) reports providing quantitative data on left ventricular (LV) structure and geometry; (3) LV hypertrophy (LVH) in hypertensives referred to echo labs. The study was carried out in 14 outpatient echo-labs across Italy. Prescriptions written by general practitioners were used to identify the indications for the examinations. Estimates of LVH were derived from original echo reports or were calculated from LV primary measures, when available, with Devereux's formula in a post-analysis. Echo examination was performed in 2449 subjects (1245 men and 1204 women); hypertension was the indication for echo in 745 (30.4%) cases. In this subgroup, LV mass (LVM), LVM indexed to body surface area, LVM indexed to height 2.7 and relative wall thickness ratio were reported in 58, 59, 54 and 52%, respectively. LVH was present in 53% of untreated hypertensives and, among treated patients, in 45 and 65% of those with and without blood pressure control, respectively. Our findings show that (1) hypertension accounts for approximately one-third of echo examinations performed in clinical practice; (2) a large fraction of echo reports do not provide quantitative data on LVM and LV geometry, (3) LVH is highly prevalent in hypertensives referred to echo labs for assessment of cardiac damage.

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Section: Echocardiography In Hypertension C Cuspidi Et Alsupporting

confidence: 92%

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

et al. 2009

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“…He showed that left ventricular mass index, left ventricular wall thickness, and prevalence of left ventricular hypertrophy were markedly increased not only in untreated hypertensive patients but also in treated hypertensives with inadequate blood pressure control, compared with values in the normotensive groups. Echocardiographic abnormalities were less in treated hypertensives with blood pressure control than in patients with inadequate blood pressure control, but values were still clearly greater than in normotensive subjects in the Mancia study [21]. Early interventions to prevent LVH in early stages of primary hypertension, and also to treat the other contributing diseases, seem to be more logical strategy.…”

Section: Discussionmentioning

confidence: 84%

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

Tamer

Sargın

et al. 2005

Endocr J

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Abstract. The aim of this prospective cross-sectional study was to investigate the hypertrophic effects of endogenous subclinical hyperthyroidism on myocardium and early development of left ventricular hypertrophy (LVH) in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. A total of 31 consecutive patients with stage I hypertension were included in the study. Sixteen of them also had endogenous subclinical hyperthyroidism that they were unaware before. The patients and the controls formed out of ten healthy subjects all underwent an investigation of thyroid functions and cardiologic evaluation. The mean wall thickness of the left ventricle in the stage I hypertensive group with endogenous subclinical hyperthyroidism (group I) was significantly increased as compared with both hypertensive patients without thyroid disease (group II) and the control subjects. The mean left ventricle mass was also significantly higher in group I than group II. Both of the patients' groups had an increased prevalence of LVH as compared with the controls. In this study, hypertensive patients with subclinical hyperthyroidism presented more increase in left ventricular mass, suggesting that subclinical hyperthyroidism may contribute to left ventricular hypertrophy forming a natural progression to hypertension. The hypertensive population should always be screened for endogenous subclinical hyperthyroidism, and should be examined for the criteria of left ventricular hypertrophy by echocardiography in early stages. SUBCLINICAL hyperthyroidism is characterized by persistently suppressed plasma thyroid stimulating hormone (TSH) concentrations and the presence of normal levels of free thyroxine (fT 4 ) and free triiodothyronine (fT 3 ) hormones. Subclinical hyperthyroidism can be the result of the same causes of overt clinical hyperthyroidism but patients with subclinical hyperthyroidism do not usually show specific symptoms and signs of hyperthyroidism [1,2]. It has been demonstrated that exogenous subclinical hyperthyroidism, in which patients treated with TSHsuppressive doses of levothyroxine, may affect the heart as in subjects with overt hyperthyroidism, but it remains controversial whether endogenous subclinical hyperthyroidism affects the heart [3][4][5].Situations in which thyroid hormones were increased have been shown to stimulate myocardial hypertrophy. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. Hypertension may also cause left ventricular myocardial hypertrophy. The importance of LVH in the prognosis of hypertension is well known because it clearly shows the duration and the severity of high blood pressure [6][7][8].Since hypertension and hyperthyroidism both may result in myocardial hypertrophy, we designed a crosssectional study to investigate the early development of LVH in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. It could

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“…The highest figures of echocardiographic LVH prevalence (475%) are reported in studies examining patients with resistant hypertension 35 and electrocardiographic evidence of LVH; 13 these studies include a significant fraction of patients with prior CV complications and the highest BP levels. Conversely, the lowest (o30%), although clinically relevant, rates of LVH are found in hypertensives surveyed in population-based studies 14,18,27 or in middle-aged, recently diagnosed, untreated hypertensives. 25,28,31,32,38 From these data, two considerations can be made: (1) a consistent fraction of treated hypertensive patients are still exposed to a high CV risk as antihypertensive treatment is unable to normalize BP and consequently reverse alterations in cardiac structure; (2) a noticeable portion of hypertensive patients (30%) enrolled in the examined studies were untreated, despite having a cardinal manifestation of organ damage such as LVH; this suggests that unsolved issues in primary prevention of CV disease include not only unsatisfactory BP control but also poor awareness of the hypertensive status and delay in hypertensive treatment.…”

Section: Discussionmentioning

confidence: 95%

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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Prevalence of Left Ventricular Hypertrophy in Hypertensive Patients Without and With Blood Pressure Control

Abstract: Abstract-Previous studies have shown that in the population, only a minority of treated hypertensive patients achieve blood pressure (BP) control. Whether and to what extent this inadequate control has reflection on hypertension-related organ damage has never been systematically examined.

Cited by 106 publications

References 31 publications

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

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

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