Regression of left ventricular hypertroiphy and risk of stroke in hypertension

Abstract

Left ventricular hypertrophy (LVH) is a risk marker for stroke and LVH regression confers protection from a composite of cardiovascular events. It is unknown whether LVH regression confers specific protection from stroke independently of ambulatory blood pressure (BP). In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale study, 880 initially untreated hypertensive subjects (mean age 48, office BP 155/98 mmHg; 24-h ambulatory BP 137/87 mmHg) underwent diagnostic tests including echocardiography and 24-h ambulatory BP monitoring at entry and after a median of 3.5 years, still in the absence of cardiovascular events. Months or years after the follow-up study, 34 of these subjects developed a first cerebrovascular event (stroke in 21, transient ischemic in 13). Event rate (x 100 patients per year) was 0.25 among the subjects who never developed echocardiographic LVH or with regression of LVH, Vs 1,16 among the subjects with lack of regression or new development of LVH (log-rank test: p = 0.00001). The serial changes in the electrocardiographic features of LVH failed to define subgroups at different risk. In a Cox analysis, the risk of cerebrovascular events was 2.8 times higher (95% CI: 1-18-6.69) in the subset with lack of regression or new development of LVH than in that with LVH regression or persistently normal LV mass. Such effect was independent of age (p=0.001) and 24-h systolic BP (p=0.003) (figure). In conclusion, regression of LVH by itself confers an improvement in risk for cerebrovascular complications in hypertensive patients. Such effect is independent of ambulatory BP and other individual risk factors. Open in new tabDownload slide