Cardiovascular risk declines in patients with essential hypertension whose left ventricular hypertrophy regresses with therapy, according to researchers in Italy.
Left ventricular hypertrophy identified by echocardiography is strongly and independently associated with increased cardiovascular risk in patients with essential hypertension, the authors explain, but few studies have investigated the prognostic relevance of left ventricular hypertrophy regression.
Dr. Sante D. Pierdomenico and colleagues from Universita 'Gabrielle d'Annunzio,' Chieti, investigated the prognostic relevance of left ventricular hypertrophy regression after two years of therapy in 387 hypertensive patients with echocardiographic evidence of left ventricular hypertrophy at baseline, with or without electrocardiographic evidence of left ventricular hypertrophy.
At the two-year follow-up, 242 patients showed regression of left ventricular hypertrophy, while145 showed persistent left ventricular hypertrophy, the authors report in the April issue of the
American Journal of Hypertension.The decrease in left ventricular mass index was significantly associated with a reduction in 24-hour systolic blood pressure but not with a reduction in clinic-recorded systolic blood pressure, the report indicates.
In a Cox regression analysis, left ventricular hypertrophy regression and decrease in left ventricular mass index were independently associated with reduced cardiovascular risk.
Cardiovascular events occurred at the rate of 1.06 per 100 patient-years in those with left ventricular hypertrophy regression and 4.4 per 100 patient-years in patients without left ventricular hypertrophy regression. There were also fewer cerebrovascular events among patients with left ventricular hypertrophy regression, the researchers note.
"The current guidelines do not seem to suggest the use of echocardiographic examination for the reevaluation of patients with known hypertensive heart disease but who show no change in clinical status," the authors note.
"However, echocardiographic examination should be repeated during treatment, provided human, financial, and infrastructural resources are available, so as to restratify the risk profile of patients and take appropriate decisions regarding future therapeutic strategy."
"To suggest that repeated echocardiographic determinations can be part of routine practice might be a little hasty," writes Dr. Philippe Gosse from University Hospital of Bordeaux, France in a related commentary. "In our experience, although left ventricular mass may be a valuable criterion, its measurement by echocardiography is not reliable enough."
"Thus although there is increasing evidence for the value of left ventricular mass as an intermediate criterion, its exploitation will necessarily be limited to therapeutic trials for some time to come," Dr. Gosse concludes.
