[Can regression of left ventricular hypertrophy be proposed as a substitute criterion in trials of morbidity/mortality in hypertension?].
Hypertension is a cardiovascular risk factor. In addition to simple normalisation of the blood pressure, the true objective of treatment of hypertension should, therefore, be reduction of the excess risk and it is in terms of morbi-mortality that the real benefits of antihypertensive therapy should be evaluated. However, trials of morbi-mortality are long and costly so that intermediate criteria are proposed for assessing therapeutic benefits with measurement of left ventricular mass as one of the best candidates. The concept is interesting but it is essential to question its clinical pertinence. In order that an intermediary criterion be acknowledged as a substitution criterion, it has to fulfil the following conditions: it must be simple, reliable and reproducible to measure it must be modifiable by therapeutic intervention it must be closely related to the degree of risk, whichever way it changes the amplitude of its changes must provide a quantitative prediction of risk-associated changes finally, in the particular case of hypertension, the benefit of the improvement of the substitute criterion should be distinguished from the benefits due to lowering the blood pressure alone. Left ventricular mass measured by echocardiography is the most documented intermediate substitution criterion over the last 20 years. It fulfils most of the conditions of a substitute criterion. However, the relationship between its reduction with treatment and the reduction of risk, independently of the change in blood pressure, remains to be shown.
Gosse
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Service de cardiologie/hypertension arterielle, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux.
Herpin
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D
D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004452:Echocardiography; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D017379:Hypertrophy, Left Ventricular / Q000145:classification / Q000473:pathology*; D009017:Morbidity; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome