What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=1872). Intervention: LVH regression vs. Persistent or newly developed LVH. Primary outcome: Composite of cardiovascular death, hospitalization for heart failure, coronary revascularization, stroke, and aortic events (HR 2.203, 95% CI 1.374-3.532, p=0.001).

What does this research mean for the field?

Persistent or newly developed left ventricular hypertrophy during antihypertensive therapy is associated with a significantly higher risk of cardiovascular events compared to LVH regression. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 20, 2022Open Access

Prognostic implication of left ventricular hypertrophy regression after antihypertensive therapy in patients with hypertension

Key Result

Persistent or newly developed left ventricular hypertrophy during antihypertensive therapy was associated with a significantly higher risk of composite cardiovascular events compared to LVH regression (HR 2.203).

Study Design

Type

Cohort (n=1,872)

Multicenter

Yes

Structured PICO

Does LVH regression after antihypertensive therapy reduce cardiovascular events in patients with hypertension?

Population

837 patients with hypertension who had left ventricular hypertrophy (LVH) at the time of diagnosis

Intervention

LVH regression after antihypertensive therapy (defined as normal geometry or concentric LV remodeling at follow-up echocardiography)

Comparator

Persistent or newly developed LVH during antihypertensive therapy

Outcome

Cardiovascular mortality, hospitalization for heart failure (HHF), coronary revascularization, stroke, and aortic eventshard clinical

LVH regression in hypertensive patients is associated with a reduction in cardiovascular events, highlighting its utility as a prognostic marker.

Main Result

Effect estimate: HR 2.203 (95% CI 1.374-3.532)

p-value: p=0.001

Limitations

Retrospective study design with data collected over a long period and inconsistent follow-up duration.
Echocardiographic evaluation performed with different vendors and sonographers.
Lack of detailed data on antihypertensive medication regimens and blood pressure variability.
Lack of cardiac magnetic resonance imaging for quantitative assessment of myocardial fibrosis.

Abstract

Background: Left ventricular (LV) hypertrophy (LVH) in patients with hypertension is a significant risk factor for cardiovascular mortality and morbidity. However, the prognostic implication of LVH regression after antihypertensive therapy has not been clearly investigated. Methods: (women). LVH regression was defined as LVH at initial echocardiography with normal geometry or concentric LV remodeling at follow-up echocardiography. Cardiovascular mortality, hospitalization for heart failure (HHF), coronary revascularization, stroke, and aortic events were analyzed according to changes in LVMI and geometry. Results: = 837) had LVH at the time of diagnosis; among these, 30.7% showed LVH regression. The reduction in LVMI was associated with the reduction in BP, especially in those with LVH at baseline. During follow up (median, 50.4 months; interquartile range, 24.9-103.2 months), 68 patients died of cardiovascular causes, 127 had HHF, and 162 had vascular events (coronary revascularization, stroke, and aortic events). Persistent or newly developed LVH during antihypertensive therapy was a significant predictor of cardiovascular mortality and events, especially HHF. On multivariable analysis, women, diabetes, atrial fibrillation, coronary artery disease, larger LVMI and end-diastolic dimension, and less reduction in systolic BP were associated with persistent or newly developed LVH. Conclusion: LVH regression in patients with hypertension is associated with a reduction in cardiovascular events and can be used as a prognostic marker.

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