Effect of Treatment of Isolated Systolic Hypertension on Left Ventricular Mass

CONTEXT: Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known. OBJECTIVE: To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH. DESIGN: Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP). PATIENTS: A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms. INTERVENTION: The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure. MAIN OUTCOME MEASURE: Change in LV mass assessed by echocardiography. RESULTS: Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m2 in the active treatment group and 100 g/m2 in the placebo group (P<.001). The LV mass index declined by 13% (95% confidence interval, - 3% to - 23%) in the active treatment group compared with a 6% increase (95% confidence interval, - 3% to + 16%) in the placebo group over 3 years (P=.01). CONCLUSION: Treatment of ISH with a diuretic-based regimen reduces LV mass.