LEFT VENTRICULAR MASS IS A PREDICTOR OF FOLLOW-UP UNCONTROLLED BLOOD PRESSURE IN HYPERTENSIVE PATIENTS: 4B.04

Abstract

Background: Left ventricular (LV) hypertrophy (LVH) is considered as a target organ response to chronic arterial hypertension and is used to stratify cardiovascular (CV) risk. LV mass (LVM) is also increased in subjects developing subsequent hypertension. Whether initial LVM also influences effective therapeutic control of blood pressure (BP) is unknown. Methods: We estimated risk of suboptimal BP control in relation to baseline LVM index (LVMi) in 4693 hypertensive outpatients from the Campaniasalute Network, with at least 1 yr follow-up (mean 4 ± 3yrs) and without prevalent CV disease (age 53 ± 11 yrs, 43% women, 5% diabetic). BP was defined uncontrolled when systolic BP> = 140mmHg or/and diastolic BP>=90mmHg (or BP>=130 or/and 80 mmHg in diabetic patients) at the last available outpatient visit. Results: Poor BP control was detected in 2240 patients (48%), despite treatment with 2 or more antihypertensive drugs. Patients with uncontrolled BP were older, more often obese (28% versus 21%) and diabetic (9% versus 1.6%), with a longer duration of hypertension and higher baseline BP, heart rate, LVMi, and prevalence of LVH (36% versus 26%, all p < 0.0001), with no difference in sex distribution. Of 1440 patients with baseline LVH, 803 (or 56%) had uncontrolled BP at follow-up, compared to 44% of those without LVH (p < 0.0001). In multivariate analyses, odds of uncontrolled BP increased significantly with higher baseline systolic BP, heart rate, BMI, duration of hypertension, diabetes (all p < 0.0001) and greater baseline LVMi (OR = 1.10/10 g/m2.7, 1.04–1.20, p = 0.002) independent of age, gender and number of medications. When specific classes of medications were added to the previous model, only use of anti-Renin-Angiotensin System reduced the risk of uncontrolled BP (OR = 0.83, 0.71–0.95, p = 0.01), with no impact for other classes of drugs (diuretics, β-blockers, Ca++-channel blockers and α-blockers). Conclusions: We conclude that in a large population of treated hypertensive patients, higher baseline left ventricular mass is significantly associated with risk of uncontrolled BP independently of age, gender, body max index, diabetes and antihypertensive therapy.