Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients.
Left ventricular (LV) mass and geometry predict risk for cardiovascular events in hypertension. Regression of LV hypertrophy (LVH) may imply an important prognostic significance. The relation between changes in LV geometry during antihypertensive treatment and subsequent prognosis has not yet been determined. A total of 436 prospectively identified uncomplicated hypertensive subjects with a baseline and follow-up echocardiogram (last examination 72+/-38 months apart) were followed for an additional 42+/-16 months. Their family doctor gave antihypertensive treatment. After the last follow-up echocardiogram, a first cardiovascular event occurred in 71 patients. Persistence of LVH from baseline to follow-up was confirmed as an independent predictor of cardiovascular events. Cardiovascular morbidity and mortality were significantly greater in patients with concentric (relative wall thickness > or =0.44) than in those with eccentric geometry (relative wall thickness <0.44) in patients presenting with LVH (P=0.002) and in those without LVH (P=0.002) at the follow-up echocardiogram. The incidence of cardiovascular events progressively increased from the first to the third tertile of LV mass index at follow-up (partition values 91 and 117 g/m2), but for a similar value of LV mass index it was significantly greater in those with concentric geometry (OR: 4.07; 95% CI: 1.49 to 11.14; P=0.004 in the second tertile; OR: 3.45; 95% CI: 1.62 to 7.32; P=0.001 in the third tertile; P<0.0001 in concentric versus eccentric geometry). Persistence or development of concentric geometry during follow-up may have additional prognostic significance in hypertensive patients with and without LVH.
Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Maria Lorenza
ML
Muiesan
Massimo
M
Salvetti
Cristina
C
Monteduro
Bianca
B
Bonzi
Anna
A
Paini
Sara
S
Viola
Paolo
P
Poisa
Damiano
D
Rizzoni
Maurizio
M
Castellano
Enrico
E
Agabiti-Rosei
D000293:Adolescent; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000473:pathology*; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D012306:Risk; D020521:Stroke / Q000453:epidemiology; D014463:Ultrasonography; D020257:Ventricular Remodeling
D000959:Antihypertensive Agents