title: Lack of reduction of left ventricular mass in treated hypertension: the strong heart study.
abstract: BACKGROUND
  Hypertensive left ventricular mass (LVM) is expected to decrease during antihypertensive therapy, based on results of clinical trials.
  
  
  RESULTS
  We assessed 4-year change of echocardiographic LVM in 851 hypertensive free-living participants of the Strong Heart Study (57% women, 81% treated). Variations of 5% or more of the initial systolic blood pressure (SBP) and LVM were categorized for analysis. At baseline, 23% of men and 36% of women exhibited LV hypertrophy (LVH, P<0.0001). At the follow-up, 3% of men and 10% of women had regression of LVH (P<0.0001 between genders); 14% of men and 15% of women, free of baseline LVH, developed LVH. There was an increase in LVM over time, more in men than in women (P<0.001). Participants whose LVM did not decrease had similar baseline SBP and diastolic BP, but higher body mass index (BMI), waist/hip ratio, heart rate (all P<0.008), and urinary albumin/creatinine excretion (P<0.001) than those whose LVM decreased. After adjusting for field center, initial LVM index, target BP, and kinship degree, lack of decrease in LVM was predicted by higher baseline BMI and urinary albumin/creatinine excretion, independently of classes of antihypertensive medications, and significant effects of older age, male gender, and percentage increase in BP over time. Similar findings were obtained in the subpopulation (n=526) with normal BP at follow-up.
  
  
  CONCLUSIONS
  In a free-living population, higher BMI is associated with less reduction of hypertensive LVH; lack of reduction of LVM is independent of BP control and of types of antihypertensive treatment, but is associated with renal damage.
authors.affiliation: Department of Translational Medical Sciences, Federico II University, Napoli, Italy. simogi@unina.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Daniela
authors.initials: D
authors.lastname: Girfoglio
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive therapy; blood pressure; obesity; proteinuria; ventricular hypertrophy