High-normal blood pressure and abnormal left ventricular geometric patterns

AIM: The association between prehypertension (pre-HTN) and abnormal left ventricular (LV) geometric patterns is unclear. We performed a meta-analysis of echocardiographic studies aimed to provide a new piece of information on LV geometric alterations in untreated pre-HTN individuals. DESIGN: Studies were identified by crossing the following search terms: 'prehypertension,' 'high normal blood pressure,' 'heart,' 'LV hypertrophy' (LVH), 'LV geometry,' 'LV mass,' and 'echocardiography.' RESULTS: A total 60 949 participants (38 536 normotensive, 14 453 pre-HTN, and 7960 HTN individuals) were included in six studies. LV concentric remodelling was the most common abnormal pattern in pre-HTN participants followed by eccentric and concentric LVH. Compared with normotensive group, pre-HTN exhibited a higher risk of LV concentric remodelling (OR 1.89, CI 1.70-2.10, P < 0.001), eccentric LVH (OR 1.65, CI 1.40-1.90, P < 0.001) and concentric LVH (OR 2.09, CI 1.50-3.00, P < 0.001). The likelihood of having abnormal LV patterns in HTN was significantly higher (P < 0.001 for all) than in pre-HTN participants. CONCLUSION: Our meta-analysis shows that alterations in LV geometry in pre-HTN individuals are intermediate between normotensive and HTN individuals. These findings suggest that pre-HTN is associated to early changes in LV structure and geometry, and preventive strategies may have a protective impact on development of subclinical cardiac damage in this setting.