title: Prevalence of residual left ventricular structural changes after one  year of antihypertensive treatment in patients of African descent: role of 24-hour pulse pressure.
abstract: OBJECTIVE
  One year of antihypertensive therapy may normalise left ventricular (LV) structure in 51% of hypertensive patients of European descent. Whether similar effects can be achieved in patients of African descent, who have a high prevalence of concentric LV hypertrophy (LVH) and remodelling, is unknown.
  
  
  METHODS
  In 103 hypertensive patients in the Baragwanath Hypertension study we evaluated the prevalence of residual LV structural changes (echocardiography) after four and 13 months of stepwise antihypertensive therapy.
  
  
  RESULTS
  After 13 months of therapy, 24-hour blood pressure control was achieved in 47% of patients. At baseline, 51.5% of patients had concentric LVH, 19% eccentric LVH and 12% concentric LV remodelling. Despite changes in LV mass index (p < 0.01) and relative wall thickness (p < 0.05) with treatment, the proportion of patients with a normal LV mass or geometry increased only from 17.5 to 25% (p > 0.05), while 26% remained with concentric LVH (p < 0.001 compared to baseline), 25% with eccentric LVH and 23% with concentric LV remodelling (p < 0.05 compared to baseline). Residual structural changes were associated with 24-hour pulse pressure (p = 0.02), but not with 24-hour systolic or diastolic blood pressure or clinic blood pressure.
  
  
  CONCLUSIONS
  Even after a year of antihypertensive therapy, a high proportion (74%) of hypertensives of African ancestry retained residual LV structural changes, an effect that was associated with 24-hour pulse pressure but not systolic or diastolic blood pressures or clinic blood pressure in this ethnic group.
authors.affiliation: Department of Cardiology, University of the Witwatersrand, and Chris Hani Baragwanath Hospital, Johannesburg, South Africa. Elena.libhaber@wits.ac.za
authors.forename: Elena N
authors.initials: EN
authors.lastname: Libhaber
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Norton
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Libhaber
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Woodiwiss
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Candy
authors.forename: Mohammed R
authors.initials: MR
authors.lastname: Essop
authors.forename: Pinhas
authors.initials: P
authors.lastname: Sareli
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents