Initial left-ventricular mass predicts probability of uncontrolled blood pressure in arterial hypertension

Abstract

Left-ventricular hypertrophy (LVH) is a marker of organ damage in hypertension and helps stratifying cardiovascular risk. Initial left-ventricular mass (LVM) is also a predictor of progression to hypertension, independently of initial blood pressure (BP) and other confounders. To evaluate whether baseline LVM can influence BP control in treated hypertension. We evaluated risk of uncontrolled BP (>140 or 90 mmHg under at least two medications), in relation to initial LVM in 4693 hypertensive outpatients (mean age 53±11 years, 43% women, 5% diabetic), without prevalent cardiovascular disease, from the Campania Salute Network. Uncontrolled BP was found in 2240 patients (48%). Participants with initial LVH were more often men, older, diabetic, had higher initial BP, fasting glucose, uric acid and triglycerides, and lower heart rate (HR), high-density lipoprotein-cholesterol and glomerular filtration rate than those without LVH (all P<0.05). Of 1440 patients with initial LVH, 803 (56%) were uncontrolled at follow-up compared to 44% without LVH (P<0.0001). In multivariate analyses, odds of uncontrolled BP increased with higher baseline systolic BP [odds ratio (OR)=1.13×5 mmHg, 95% confidence interval (CI) 1.10-1.15], HR (OR=1.04×5 beats/min, 95% CI 1.01-1.07), BMI (OR=1.03×kg/m, 95% CI 1.01-1.04), LVM index (OR=1.05×5 g/m, 95% CI 1.01-1.10) and prevalence of diabetes (OR=5.22, 95% CI 3.52-7.76; all P<0.05) independently of age, sex, metabolic parameters and number of antihypertensive meds (P>0.1). Among medication classes, only angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were associated with lower risk of uncontrolled BP (OR=0.83, 95% CI 0.71-0.96; P=0.01), independently of covariates. In a population of treated hypertensive patients, initial LVM is a significant predictor of uncontrolled BP, independently of major risk factors and antihypertensive therapy.