Left ventricular hypertrophy: reduction of blood pressure already in the normal range further regresses left ventricular mass.
OBJECTIVE
Left ventricular hypertrophy (LVH) confers high cardiovascular risk. Regression of LVH reduces risk. Patients with blood pressure in the normal range and LVH are common. We investigated whether further reduction in blood pressure would further regress LVH.


METHODS
51 subjects with blood pressure in the normal range and echocardiographic left ventricular hypertrophy were randomly assigned to active treatment (antihypertensive medication) or placebo in a ratio of 2:1. The aim was to maintain office systolic blood pressure at 10 mm Hg less than baseline in the active arm and at baseline level in the placebo arm. Cardiac magnetic resonance imaging was used to measure change in left ventricular mass index over 12 months.


RESULTS
35 subjects completed the study (active 23: placebo 12). Average mean baseline office systolic blood pressure was 122 (SD 9) mm Hg in the active group and 124 (9) mm Hg in the placebo group (p = 0.646). The mean baseline left ventricular mass index was 65.88 (11.87) g/m(2) in the active group and 59.16 (11.13) g/m(2) in the placebo group (p = 0.114). The mean difference between baseline and end of study office systolic blood pressure was -9.33 (8.56) mm Hg in the active group and -0.08 (9.27) mm Hg in the placebo group (p = 0.007). The mean change in left ventricular mass index was -4.68 (7.31) g/m(2) in the active group and +1.97 (6.68) g/m(2) in the placebo group (p = 0.014).


CONCLUSIONS
Reduction in office systolic blood pressure, already in the normal range, of approximately 9 mm Hg, leads to a reduction in left ventricular mass. Further work is required to see if this also leads to a reduction in cardiovascular events.


BACKGROUND
ISRCTN48331653.
Simpson
H J
HJ
Division of Medical Sciences, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Gandy
S J
SJ
Houston
J G
JG
Rajendra
N S
NS
Davies
J I
JI
Struthers
A D
AD
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012307:Risk Factors; D016037:Single-Blind Method
D000959:Antihypertensive Agents