Left ventricular mass change during treatment and outcome in patients with essential hypertension.

BACKGROUND

It is uncertain whether reduction of left ventricular (LV) mass during antihypertensive treatment predicts reduces cardiovascular complications of hypertension.

METHODS

A total of 172 prospectively identified patients with essential hypertension without complications of hypertension at baseline and follow-up echocardiograms 5.5 +/- 3.0 years apart, were followed an additional 4.8 +/- 2.9 years. Antihypertensive treatment was determined by primary physicians.

RESULTS

After the second echocardiograms, cardiovascular events occurred in 24 patients (14%). Fewer of the 91 patients with unchanged or decreased LV mass experienced cardiovascular events than of the 81 patients whose LV mass increased during follow-up (8.8% [95% confidence interval (CI): 3.9%-13.7%] v 19.8% [95% CI 12.6%-27.0%]; P =.04) despite greater baseline LV mass in the former group (118 g/m(2) [95% CI 111-125] v 95 g/m(2) [95% CI 88-102]; P <.0001). Absence or presence of LV hypertrophy on the follow-up echocardiogram was the strongest predictor of relatively low (9.2% [95% CI 5%-13.4%]) v high (28.6% [95% CI 17.1%-40.1%]; P =.004) rates of subsequent morbid events. In multivariate analyses, only LV mass index at follow-up consistently predicted adverse outcomes.

CONCLUSIONS

The LV mass reduction during antihypertensive treatment is associated with reduced rate of complications of essential hypertension. Our data further suggest that development or regression of LV hypertrophy during antihypertensive treatment may be more closely linked to prognosis than are changes in clinic blood pressure.