Relationship between treatment-induced changes in left ventricular mass and blood pressure in black African hypertensive patients. Results of the Baragwanath trial

Skudicky, Daniel; Sareli, Pinhas; Libhaber, Elena; Candy, Geoffrey P.; RADEVSKI, I; Valtchanova, Z.P.; Tshele, E.; Thijs, Lutgarde; Wang, Ji‐Guang; Staessen, Jan A

doi:10.1016/s1062-1458(02)00703-1

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…Fortunately, HT is an easily detectable condition that can be readily controlled with treatments that are not only cheap, but relevant to salt-sensitive black Africans (e.g., thiazides and dihyrdopiridine calcium antagonists) [16] in whom regression of LVH is achievable. [17] In this context, it is clear from our own [9] and previous African and African-American [18] studies that HT is an extremely important antecedent for HF. However, the progression from concentric LVH to HF has not well been defined in Africa.…”

Section: Discussionmentioning

confidence: 78%

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Stewart¹,

Libhaber²,

Carrington³

et al. 2011

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 78%

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Stewart¹,

Libhaber²,

Carrington³

et al. 2011

International Journal of Cardiology

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“…Prior studies conducted in this population group have demonstrated that change in BP predict decreases in LVM in newly diagnosed, but not in previously treated patients irrespective of whether LVH was present. 12 Figure 1 Correlation coefficients, adjusted for sex and baseline LVMI between change in ABP and change in LVMI following 5 months of antihypertensive therapy (n ¼ 47).…”

mentioning

confidence: 99%

Change in blood pressure predicts regression of cardiac hypertrophy in patients of African ancestry receiving agents influencing the renin–angiotensin system

et al. 2005

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“…The study design has been described previously. 26,27 Hypertensives of black African descent 18 to 70 years of age, free of clinically significant cardiovascular and noncardiovascular disease, were enrolled. Hypertension was diagnosed after a 2-week placebo run-in period, if daytime ambulatory diastolic BP was 90 to 114 mm Hg.…”

Section: Study Groupmentioning

confidence: 99%

“…26,27 Ambulatory 24-hour, day, and night BP were determined using SpaceLabs monitors (model 90207), as described previously.…”

Section: Blood Pressurementioning

confidence: 99%

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Relationship Between On-Treatment Decreases in Inappropriate Versus Absolute or Indexed Left Ventricular Mass and Increases in Ejection Fraction in Hypertension

Woodiwiss

Libhaber

et al. 2012

Hypertension

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Abstract-Although) LVMI decreased with treatment, treatment failed to increase EF in either group (1.2Ϯ10.8% and 2.7Ϯ10.7%, respectively). In contrast, in patients with inappropriate LV hypertrophy (LVM inappr Ͼ150%; nϭ33) LVM inappr decreased (Ϫ32Ϯ27%; PϽ0.0001) and EF increased (5.0Ϯ10.3%; PϽ0.05) after treatment, whereas in patients with an LVM inappr Յ150% (nϭ135), neither LVM inappr (Ϫ0.5Ϯ23%) nor EF (0.9Ϯ10.3%) changed with therapy. With adjustments for circumferential LV wall stress and other confounders, whereas on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial rϭ0.17; PϽ0.05), on-treatment decreases in LVM inappr were strongly related to increases in EF even after further adjustments for LVM or LVMI (partial rϭϪ0.63 [CI, Ϫ0.71 to Ϫ0.52]; PϽ0.0001). In conclusion, decreases in LVM inappr are strongly related to on-treatment increases in EF beyond changes in LVM and LVMI. LV hypertrophy can, therefore, be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, it can be viewed as a pathophysiological process accounting for a reduced EF. 1-7 and the development of a reduced ejection fraction (EF) 8 independent of myocardial infarction. LV mass (LVM) may, therefore, determine the progression to heart failure with a reduced rather than a preserved EF. 9,10 However, in keeping with the classic tenet that LVH is a compensatory response to LV load, an increased LVM 11-13 or on-treatment decreases in LVM 14 have been associated with an unchanged EF. Moreover, LVH may even be associated with an enhanced EF for that predicted by wall stress, 15 and on-treatment decreases in LVM have been related to reductions rather than increases in indices of systolic LV chamber function. 16 There is, therefore, considerable uncertainty as to whether LVH contributes to decreases in systolic chamber function.One possibility that may explain discrepancies in the ability to show consistent relations between LVM or LVM index (LVMI) and a reduced systolic LV chamber function [11][12][13][14][15][16] is that absolute LVM and LVMI may incorporate a component of LVH considered compensatory in nature, whereas there may also be a component of LVH that contributes to decompensation. In this regard, LVM in excess of that predicted by workload (ie, stroke workϭblood pressure [BP]ϫstroke volume), termed "inappropriate LVM" (LVM inappr ), 17 is inversely associated with systolic LV chamber function.18-25 However, these relationships have largely been demonstrated in cross-sectional studies [18][19][20][21][22][23][24] and are at odds with on-treatment decreases in systolic LV chamber function associated with LVH regression. 16 Inverse LVM inappr ϪLV systolic chamber function relations 18-24 may, therefore, reflect compensatory increases in LVM as a consequence of systolic dysfunction or associated confounding effects. Although one previous study has reported that on-treatment regression but not persistence of LVM inappr is associated with an improved EF, 25 wh...

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Relationship between treatment-induced changes in left ventricular mass and blood pressure in black African hypertensive patients. Results of the Baragwanath trial

Cited by 10 publications

References 23 publications

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Change in blood pressure predicts regression of cardiac hypertrophy in patients of African ancestry receiving agents influencing the renin–angiotensin system

Relationship Between On-Treatment Decreases in Inappropriate Versus Absolute or Indexed Left Ventricular Mass and Increases in Ejection Fraction in Hypertension

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