Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values.
OBJECTIVE
Previous studies have shown that left ventricular hypertrophy (LVH) represents a cardiovascular risk factor independently of clinic blood pressure (BP). The present study was aimed at determining the impact of LVH on the incidence of cardiovascular morbid and fatal events taking into account not only classical risk factors but also home and ambulatory BP values, which have been shown to have an important independent prognostic impact.


METHODS
In 1716 patients belonging to the 'Pressioni Arteriose Monitorate E Loro Associazioni' population of Monza, we quantified left ventricular mass index and identified LVH by standard cutoff values. We also measured clinic, home and 24-h ambulatory BPs together with serum glucose and lipids.


RESULTS
During a follow-up of 148 months, the rate of fatal and nonfatal (hospitalizations) cardiovascular events as well as of all-cause death was markedly greater (four-fold to five-fold) in patients as compared with those without LVH. In LVH individuals, the increased risk remained significant even when data were adjusted for a large number of other confounding factors including home BP, 24-h mean BP and ambulatory BP. Results were similar when left ventricular mass was indexed by height and body surface area. A 10% increase in left ventricular mass index was associated with a significant increase in cardiovascular risk or all-cause deaths. In multivariate analysis, left ventricular mass index was always an independent predictor of cardiovascular events and death for any cause.


CONCLUSIONS
Our data provide evidence that LVH is an important risk factor even when the contribution of different BPs to risk is fully taken into account.
Bombelli
Michele
M
Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza (Milan), Italy.
Facchetti
Rita
R
Carugo
Stefano
S
Madotto
Fabiana
F
Arenare
Francesca
F
Quarti-Trevano
Fosca
F
Capra
Anna
A
Giannattasio
Cristina
C
Dell'Oro
Raffaella
R
Grassi
Guido
G
Sega
Roberto
R
Mancia
Giuseppe
G
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000401:mortality / Q000503:physiopathology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012307:Risk Factors; D015996:Survival Rate