title: Factors Contributing to Development and Reversal of LVH: A Pilot Study.
abstract: BACKGROUND
  Left Ventricular Hypertrophy (LVH) often reflects as a physiological adaptation to chronic pressure overload. It has been identified as a strong independent risk factor of all-cause mortality and adverse cardiac events. Since not all subjects with hypertension develop LVH, understanding the clinical factors contributing to the development of LVH and the appropriate diagnostic and treatment strategies may help clinicians in conducting more definitive evaluation and managing the disease effectively.
  
  
  OBJECTIVE
  To assess the incidence of LVH in hypertensive subjects and the factors influencing its development and reversal. The study also evaluated the most effective diagnostic technique and therapy that could improve the disease symptoms and prognosis.
  
  
  METHODS
  The prospective study, conducted at Jagadguru Sri Shivarathreeshwara (JSS) Medical College JSS University, Mysore, India, included 50 patients with hypertension. Detailed history of the recruited subjects was collected from patient records and through physical examination. Demographic and clinical characteristics such as age, gender, BMI, and stage of hypertension (stage I HTN and stage II HTN) were also obtained. Funduscopic examination was done for all patients for evidence of hypertensive retinopathy. Echocardiography (ECHO), electrocardiography (ECG), and chest X-Ray were used for detection of LVH. The patients were reviewed after six months and reassessment of LVH was carried out. Statistical analysis was conducted using SPSS software and R 3.2 package.
  
  
  RESULTS
  Angiotensin-Converting Enzyme (ACE) inhibitors were found to be more effective in the treatment of LVH when compared to calcium channel blockers and beta blockers. ECHO was found to be the best method to diagnose LVH. In patients with stage I HTN, 47.1% had normal LVM. Around 53% of the subjects with stage I HTN and all with stage II HTN had abnormal LVM. Retinal changes were noted in 96.2% of abnormal LVM patients and 50% of normal LVM patients. A positive association between BMI and LVH (OR: 1.39) was also noted.
  
  
  CONCLUSIONS
  BMI may positively influence LVH regression. The presence of retinopathy, in addition to LVH, suggests an increased chance of regression with anti-hypertensive treatment.
authors.affiliation: Assistant Professor, Department of Medicine, JSS Medical College & Hospital, JSS University , Mysore, Karnataka, India .
authors.forename: Prasanna Kumar Hassan
authors.initials: PK
authors.lastname: Ramaswamy
authors.affiliation: Associate Professor, Department of Medicine, JSS Medical College & Hospital, JSS University , Mysore, Karnataka, India .
authors.forename: M
authors.initials: M
authors.lastname: Bhanukumar
authors.affiliation: Professor, Department of Medicine, JSS Medical college & Hospital, JSS University , Mysore, Karnataka, India .
authors.forename: Basavanagowdappa
authors.initials: B
authors.lastname: Hathur
authors.affiliation: Associate Professor, Department of Medicine, JSS Medical College & Hospital, JSS University , Mysore, Karnataka, India .
authors.forename: K C
authors.initials: KC
authors.lastname: Shashidhara
authors.affiliation: Associate Professor, Department of Medicine, JSS Medical College & Hospital, JSS University , Mysore, Karnataka, India .
authors.forename: K M
authors.initials: KM
authors.lastname: Srinath
keywords: BMI; Echocardiography; Hypertrophy; LVM; Retinopathy