Relationship between treatment-induced changes in left ventricular mass and blood pressure in black african hypertensive patients: results of the Baragwanath Trial.
BACKGROUND
In a single-center study, we compared to what extent changes in conventional and ambulatory blood pressure (BP) predicted regression of left ventricular mass (LVM) index in response to antihypertensive treatment in previously untreated and treated patients with sustained hypertension.


RESULTS
We enrolled 173 black African patients who, off treatment, had a daytime diastolic BP ranging from 90 to 114 mm Hg. Antihypertensive drugs were titrated and combined to reduce the daytime diastolic BP below 90 mm Hg. Echocardiograms were obtained at baseline and follow-up. Mean systolic/diastolic clinic BP, 24-hour BP, and LVM index were similar in previously untreated (n=64) and previously treated (n=109) patients and averaged 171/102 mm Hg, 151/97 mm Hg, and 118 g/m2, respectively. At 4 months, these values had decreased (P<0.001) by 26/12 mm Hg, 23/14 mm Hg, and 14 g/m2 in previously untreated patients and by 22/9 mm Hg, 21/13 mm Hg, and 19 g/m2 in previously treated patients. In the previously untreated patients, the regression in LVM index correlated to a similar degree (P=0.09) with the decreases in the conventional (r=0.34; P=0.005) and the 24-hour (r=0.26; P=0.04) systolic BP. In the previously treated patients, the corresponding correlations were 0.02 (P=0.82) and -0.10 (P=0.32), respectively. Compared with the 24-hour systolic BP, automated oscillometric measurements of systolic BP obtained at the clinic yielded similar results.


CONCLUSIONS
In previously untreated patients with sustained hypertension followed at a single center, reductions in clinic and ambulatory systolic pressure in response to antihypertensive treatment equally predicted the regression in LVM index.
Skudicky
Daniel
D
Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa. dskudi@icon.co.za
Sareli
Pinhas
P
Libhaber
Elena
E
Candy
Geoffrey
G
Radevski
Ivo
I
Valtchanova
Zdravska
Z
Tshele
Elizabeth
E
Thijs
Lutgarde
L
Wang
Ji-Guang
JG
Staessen
Jan A
JA
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003971:Diastole; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008750:Methyldopa / Q000627:therapeutic use; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use; D010349:Patient Compliance; D012044:Regression Analysis; D013019:South Africa; D013599:Systole; D014700:Verapamil / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D006852:Hydrochlorothiazide; D008750:Methyldopa; D004656:Enalapril; D014700:Verapamil; D009543:Nifedipine