Key result
Initial left-ventricular hypertrophy was associated with a higher rate of uncontrolled blood pressure at follow-up compared to patients without hypertrophy (56% vs 44%; P<0.0001).
Why the study?
Does initial left-ventricular mass predict the probability of uncontrolled blood pressure in treated hypertensive outpatients?
Cohort (n=4,693)
Yes
Does initial left-ventricular mass predict the probability of uncontrolled blood pressure in treated hypertensive outpatients?
Initial left-ventricular mass is a significant independent predictor of uncontrolled blood pressure in treated hypertensive patients, suggesting it could help identify patients requiring more aggressive antihypertensive therapy.
May aid risk stratification for uncontrolled BP; leaves open whether LVH regression improves control.
BACKGROUND: Left-ventricular hypertrophy (LVH) is a marker of organ damage in hypertension and helps stratifying cardiovascular risk. Initial left-ventricular mass (LVM) is also a predictor of progression to hypertension, independently of initial blood pressure (BP) and other confounders. OBJECTIVES: To evaluate whether baseline LVM can influence BP control in treated hypertension. METHODS: We evaluated risk of uncontrolled BP (>140 or 90 mmHg under at least two medications), in relation to initial LVM in 4693 hypertensive outpatients (mean age 53±11 years, 43% women, 5% diabetic), without prevalent cardiovascular disease, from the Campania Salute Network. RESULTS: Uncontrolled BP was found in 2240 patients (48%). Participants with initial LVH were more often men, older, diabetic, had higher initial BP, fasting glucose, uric acid and triglycerides, and lower heart rate (HR), high-density lipoprotein-cholesterol and glomerular filtration rate than those without LVH (all P<0.05). Of 1440 patients with initial LVH, 803 (56%) were uncontrolled at follow-up compared to 44% without LVH (P<0.0001). In multivariate analyses, odds of uncontrolled BP increased with higher baseline systolic BP [odds ratio (OR)=1.13×5 mmHg, 95% confidence interval (CI) 1.10-1.15], HR (OR=1.04×5 beats/min, 95% CI 1.01-1.07), BMI (OR=1.03×kg/m, 95% CI 1.01-1.04), LVM index (OR=1.05×5 g/m, 95% CI 1.01-1.10) and prevalence of diabetes (OR=5.22, 95% CI 3.52-7.76; all P<0.05) independently of age, sex, metabolic parameters and number of antihypertensive meds (P>0.1). Among medication classes, only angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were associated with lower risk of uncontrolled BP (OR=0.83, 95% CI 0.71-0.96; P=0.01), independently of covariates. CONCLUSION: In a population of treated hypertensive patients, initial LVM is a significant predictor of uncontrolled BP, independently of major risk factors and antihypertensive therapy.
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Izzo et al. (2011) conducted a cohort in Arterial hypertension (n=4,693). Initial left-ventricular hypertrophy (LVH) / mass (LVM) vs. No initial LVH was evaluated on Uncontrolled blood pressure (>140 or 90 mmHg under at least two medications) (OR 1.05 per 5 g/m, 95% CI 1.01-1.10, p=<0.0001). Initial left-ventricular hypertrophy was associated with a higher rate of uncontrolled blood pressure at follow-up compared to patients without hypertrophy (56% vs 44%; P<0.0001).
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