Open AccessLack of Reduction of Left Ventricular Mass in Treated Hypertension: The Strong Heart Study
Author(s) -
Simone Giovanni,
Devereux Richard B.,
Izzo Raffaele,
Girfoglio Daniela,
Lee Elisa T.,
Howard Barbara V.,
Roman Mary J.
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000144
Subject(s) - medicine , left ventricular hypertrophy , blood pressure , body mass index , creatinine , cardiology , diastole , population , endocrinology , excretion , heart rate , environmental health
Background Hypertensive left ventricular mass ( LVM ) is expected to decrease during antihypertensive therapy, based on results of clinical trials. Methods and 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.