January 1, 2005Open Access

Prospective Study of the Changes in Left Ventricular Mass and Geometry Patterns in Hypertensive Patients During 5 Years of Follow-up

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Essential hypertension (n=100). Intervention: Adequate blood pressure control vs. Poorly controlled or untreated hypertension. Primary outcome: Left ventricular mass index (LVMI) at 5 years (p=<0.05).

Key Result

Adequate blood pressure control over 5 years significantly reduced left ventricular mass index from 138 to 112 g/m2 (p<0.05), whereas untreated hypertension led to progressive hypertrophy.

Study Design

Type

Observational (n=100)

Multicenter

PICO

Population

100 adult patients with essential hypertension, free of concomitant cardiovascular disease or diabetes, followed prospectively for 5 years to assess changes in left ventricular mass and geometry.

Exposure / Comparator

Adequate blood pressure control vs Poorly controlled or untreated hypertension

Primary Outcome

Left ventricular mass index (LVMI) at 5 years, p=<0.05

Main Result

Absolute Event Rate: 112% vs 164%

p-value: p=<0.05

Limitations

Small sample size limits comparisons between different treatment regimens.
Lack of randomization and prospective systematic evaluation of blood pressure.
Lack of treatment standardization due to the observational design of the study.
Relatively low dose of ACE inhibitors used in some patients.

Abstract

BACKGROUND: Left ventricular hypertrophy (LVH), as well as the geometry pattern of the left ventricle, is believed to be an independent risk factor for hypertension. The present study investigated the changes in left ventricular mass, diastolic function and geometry in hypertensive patients in a prospective 5-year follow-up in conjunction with an evaluation of the regularity and effectiveness of treatment. METHODS AND RESULTS: One hundred hypertensive patients older than 18 years were examined according to the study protocol, which included registration of weight, height, vital signs, and echocardiography. After 5 years a repeat examination was performed. Patients were divided into 3 groups according to blood pressure (BP) control: group 1 (n=32), no regular medication; group 2 (n=44), regular treatment but no target BP levels; group 3 (n=14), regular effective treatment. In group 1 an increase in LVH and worsening of diastolic function were observed; in group 2 LVH and isovolumetric relaxation time remained unchanged, while the early peak velocity/atrial peak velocity ratio decreased; in group 3 there was a significant decrease in LVH. The geometry pattern only changed in 21 (23%) patients. CONCLUSIONS: LVH can be successfully reversed in only hypertensive with adequate BP control. The remodeling pattern appears to be a stable characteristic of the patient and transformation of one pattern into another is infrequent.

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