Lack of regression of left ventricular hypertrophy is accompanied by adverse prognosis in essential hypertensives

Abstract

Purpose: Presence of left ventricular hypertrophy (LVH) is considered to be associated left atrial (LA) enlargement. We sought to investigate the prognostic role of LVH regression regarding incidence of atrial fibrillation in essential hypertension. Methods: We prospectively followed up for a median period of 4.3 years 1083 essential hypertensives (mean age 57.7 years, baseline office BP=143.8/89.9mmHg). All subjects visited periodically the outpatient hypertensive unit of our institution and office BP at follow up was calculated based on the measurements of the last 3 visits. Echocardiographic evaluation and determination of the metabolic profile and creatinine levels was performed at entry and at follow up. LVH was defined as LV mass index ≥116g/m2 in men and LV mass index ≥96g/m2 in women. Endpoint of interest was new-onset AF. Results: At the end of follow up the incidence of the composite end-point was 4.3% (16 patients with stroke, 31 with CAD). According to the presence of LVH at baseline (20.5%) and at the end of follow-up (15.8%) patients were divided in two groups: with normal LV mass index at both examinations or with LVH at baseline and regression of hypertrophy (n=912, 84.2%, group 1) and with LVH at baseline and at follow-up and with normal LV mass index at baseline and LVH at follow-up (n = 171, group 2). Hypertensives of group 2 compared to those of group 1 were older (by 6.5 years, p<0.001), more frequently females (by 16.7%, p<0.001) and had at baseline greater duration of hypertension (by 2.8 years, p<0.001), increased body mass index (by 0.8kg/m2, p=0.023), office pulse pressure levels (by 3.7mmHg, p=0.003) and decreased glomerular filtration rate (by 3.4 ml/min/m1.73). Survival analysis revealed that hypertensives without LVH regression (group 2) compared to those of group 1 exhibited significantly higher rates of stroke (5.8% vs. 0.7%, log rank p=0.004) and the composite end-point (9.4% vs. 4.4%, log rank p=0.004). Conclusions: Lack of regression of LVH is accompanied by adverse prognosis in essential hypertensives.