Relationship between obesity decrease and regression of hypertensive left ventricular hypertrophy

There is a well-known relationship between obesity and hypertensive left ventricular hypertrophy. However, less is known about the relationship between obesity decrease and regression of hypertensive left ventricular hypertrophy. Aim of the study is assessment of relationships between obesity decrease and regression of hypertensive left ventricular hypertrophy. Number of 73 patients with II-III stage hypertension (43 male), average age 55.9 ± 8 and LVH determinated by echocardiography (average left ventricular mass (LVM) index: 164 ± 32 g/m2; Penn convention) have been treated (by medication and by diet) for a year. Each subject underwent two-dimensional and Doppler echocardiography,12-lead ECG, exercise stress testing (Bruce - protocol), 24-h ambulatory monitoring blood pressure, 24-h Holter monitoring with Lown classification of ventricular arrhythmia's and heart rate variability. Mean body mass index (BMI) was 28.7 ± 3.6 kg/m2 (23 to 39), and 28 (39%) patients were obese (BMI > 30 kg/m2) (OH group). After one year systolic BP (SBP) was reduced on average 168 ± 26 to 158.2 ± 21 mmHg, diastolic BP (DBP) from 102 ± 12.7 to 97 ± 11 mmHg. LV mass index was reduced from 163 ± 32 to 150.2 ± 27 g/m2 (all p<0.001). 22 patents (30.1%) lost weight more than 5%. These patients significantly decreased LV mass 309 ± 79 vs 278.4 ± 61 g; t=3.22 p<0.004), LV mass index (161 ± 35 vs 148 ± 29 kg/m2; t=2.68; p<0.02), LV diastolic dimension (52.3 ± 4.7 vs 50.5 ± 4.4 mm; t=2.95, p<0.008), Cornell's index (1.55 ± 0.4 vs 1.41 ± 0.4, p<0.02), peak double product (DP) (27.3 ± 5 vs 24.4 ± 5, t=2.8, p<0.02), DP/METTs (2.48 ± 1 vs 1.84 ± 1, t=2,15; p< 0.05), mean 24h systolic BP (SBP) (144.1 ± 17 vs 138.6 ± 16 mmHg, t=2.2 p<0.04), mean 24h diastolic BP (DBP) (89.5 ± 11 vs 85.7 ± 12 mmHg, t=2.2, p<0.04), mean SBP per day (148.2 ± 18 vs 141 ± 16 mmHg, t=2.6, p<0.02), mean DBP per day (92.7 ± 11 vs 88 ± 13 mmHg, t=2.6, p < 0.02) and increase of mean 24h RR intervals per night (938.2 vs 999 ms; t=3, p<0,007). Patients (51.70%) who didn’t achieve significant loss of weight significantly decreased LV mass index (163 ± 30 vs 152 ± 25 kg/m2; t=2.1; p<0.05), office SBP (170.3 ± 27 vs 158.9 ± 19, t=2.2, p<0.03), grades of ventricular arrhythmias (2.73 vs 1.95, t=2.1, p < 0.04), and mean VES/24h (66.6 vs 20, t=2.22, p<0.04). Hypertensive patients with LVH with significant loss of weight after one year, achieved higher grade of LVH regression, lower DP at exercise, lower values of BP during 24-hour monitoring and improvement of heart rate variability, than patients without significant loss of weight.