title: Regression of left ventricular hypertrophy and microalbuminuria changes during antihypertensive treatment.
abstract: OBJECTIVE
  The objective of the present study was to assess the regression of left ventricular hypertrophy (LVH) during antihypertensive treatment, and its relationship with the changes in microalbuminuria.
  
  
  METHODS
  One hundred and sixty-eight previously untreated patients with echocardiographic LVH, 46 (27%) with microalbuminuria, were followed during a median period of 13 months (range 6-23 months) and treated with lifestyle changes and antihypertensive drugs. Twenty-four-hour ambulatory blood pressure monitoring, echocardiography and urinary albumin excretion were assessed at the beginning and at the end of the study period.
  
  
  RESULTS
  Left ventricular mass index (LVMI) was reduced from 137 [interquartile interval (IQI), 129-154] to 121 (IQI, 104-137) g/m (P < 0.001). Eighty-nine patients (53%) had a reduction in LVMI of at least 17.8 g/m, and an LVH regression rate of 43.8 per 100 patient-years [95% confidence interval (CI) 35.2-53.9]. The main factor related to LVH regression was the reduction in SBP24 h [multivariate odds ratio (ORm) 4.49; 95% CI 1.73-11.63; P = 0.005, highest tertile compared with lower tertiles]. Male sex (ORm 0.39; 95% CI 0.17-0.90; P = 0.04) and baseline glomerular filtration rate less than 90 ml/min per 1.73 m (ORm 0.39; 95% CI 0.17-0.90; P = 0.03) were associated with a lower probability of LVH regression. Patients with microalbuminuria regression (urinary albumin excretion reduction >50%) had the same odds of achieving regression of LVH as patients with normoalbuminuria (ORm 1.1; 95% CI 0.38-3.25; P = 0.85). However, those with microalbuminuria at baseline, who did not regress, had less probability of achieving LVH regression than the normoalbuminuric patients (OR 0.26; 95% CI 0.07-0.90; P = 0.03) even when adjusted for age, sex, initial LVMI, GFR, blood pressure and angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) treatment during the follow-up.
  
  
  CONCLUSIONS
  Patients who do not have a significant reduction in microalbuminuria have less chance of achieving LVH regression, independent of blood pressure reduction.
authors.affiliation: Hypertension Clinics of Sagunto Hospital bHospital Clinico, University of Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodilla
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Pascual
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Costa
authors.forename: Joaquin
authors.initials: J
authors.lastname: Martin
authors.forename: Carmen
authors.initials: C
authors.lastname: Gonzalez
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000628:therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D000959:Antihypertensive Agents