Hypertrophy In Hypertensive Patients Research Articles

Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low-risk subset of eccentric hypertrophy in hypertensive patients.

Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients. In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/body surface area ≥116 and ≥96 g/m(2) in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not. Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group. http://www.clinicaltrials.gov. Unique identifier: NCT00338260.

Association of serum vitamin D with left ventricular hypertrophy in hypertensive patients

Are left ventricular hypertrophy (LVH) in electrocardiography (EKG) an accurate increased lv mass and a surrogate marker for cardiovascular events in hypertensive patients? Hye-Sun Seo, Mi-Jeong Kim, In Hyun Jung. Incheon St.Marys Hospital, the Catholic University of Korea, Incheon, Korea, Republic of; Sejong General Hospital, Bucheon, Korea, Republic of; Soonchunhyang Universtiy Hospital, Bucheon, Korea, Republic of

Prevalencia de hipertrofia ventricular izquierda en pacientes hipertensos

Antecedentes: se ha documentado a la hipertrofia ventricular izquierda como una de las manifestaciones tempranas de afectación cardiaca en la enfermedad hipertensiva. Objetivo: evaluar la prevalencia de hipertrofia ventricular izquierda en los pacientes hipertensos que asisten a los programas de control en instituciones de salud de Boyacá. Material y métodos: mediante muestreo secuencial aleatorio se ensambló una muestra de 1275 pacientes a quienes se realizó valoración de la presión arterial y electrocardiograma. Se evaluaron criterios de Cornell, Romhilt-Estest y Rodríguez-Padial para determinar la presencia de hipertrofia ventricular izquierda. Resultados: se encontró prevalencia global de 17.9% de HVI en los pacientes analizados, con marcadas diferencias por municipio. La HVI se encontró asociada con edad mayor de 65 años, sexo femenino, índice de masa corporal aumentado y cifras elevadas de presión sistólica y diastólica. Conclusión: estos resultados sugieren la necesidad de incrementar los programas de tamizaje y control de la presión arterial, así como de incluir capacitación a los agentes de salud en la valoración de evidencia sugestiva de HVI como alteraciones electrocardiográficas y diferencias en las presionesentre las dos extremidades superiores

Correlation Between Systolic Deformation and Dyssynchrony Indices and the Grade of Left Ventricular Hypertrophy in Hypertensive Patients With a Preserved Systolic Ejection Fraction Undergoing Coronary Angiography, Based on Tissue Doppler Imaging

The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy. A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole. The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal-lateral wall delay (r = 0.497), 6-basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = -0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end-systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839-26.980; P = .0044). Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.

Sex differences in the association between serum uric acid levels and cardiac hypertrophy in patients with chronic kidney disease

Several studies have documented an association between serum uric acid (SUA) concentration and cardiac hypertrophy in hypertensive patients; however, the association remains unclear in chronic kidney disease (CKD) patients. If there is an association between SUA and hypertrophy in these patients, it is unknown whether the association is different between men and women. Our aim in this study is to determine whether SUA is associated with cardiac hypertrophy in CKD patients, focusing on any sex differences. Two hundred sixteen CKD patients (117 men and 99 women) were enrolled in this cross-sectional study. Patients prescribed uric acid-lowering agents and those with congestive heart failure, valvular heart disease, or ischemic heart disease were excluded from this study. Left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) were assessed using echocardiography. The prevalence of LVH was 58% in men and 47% in women. In multivariate linear regression analysis, SUA levels did not correlate with LVMI in men, whereas SUA was independently associated with LVMI in women (β=0.27, P=0.02). Multivariate logistic regression analysis also revealed that diabetes mellitus (odds ratio (OR), 4.41; P=0.01) was associated with LVH in men, whereas age (OR, 1.13; P<0.01), hypertension (OR, 7.38; P=0.03) and SUA (OR, 1.91; P=0.03) were associated with LVH in women. In female CKD patients, SUA levels were associated with LVMI and LVH, whereas there was no association in male patients. These observations suggest that an association between SUA levels and the development of cardiac hypertrophy is more likely in women than in men.

Vitamin D is independently related to left ventricular hypertrophy in hypertensive patients, whereas effect of parathyroid hormone on left ventricular mass is mediated by blood pressure

Objective: Vitamin D and parathyroid hormone (PTH) may affect structure and function of left ventricle in patients with kidney disease. The aim of this study was to investigate associations of serum 25-hydroxyvitamin D (25(OH)D) and PTH concentrations with left ventricular hypertrophy in hypertensive patients. Methods: We examined 41 patients with essential hypertension (M/F 15/26, mean age=62.3±4.5 yrs), 32 of whom (81%) were receiving antihypertensive treatment. ABPM monitors (SpaceLabs 90207) were programmed to obtain measurements each 15 min. during the day (6.00-22.00) and each 30 min. nighttime. Anthropometric data were collected with standardized protocol. Two-dimensionally guided M-mode echocardiography (VIVID 7 GE Pro) was performed to measure left ventricular structure. Left ventricular mass index (LVMI) was calculated as LVM divided by body surface area. Serum 25(OH)D and intact PTH concentrations were measured. In our analyses we adjusted for covariables. Results: Based on the results of the echocardiographic examination, the study group was divided into patients with LVH (LVH+, n=19) and those without LVH (LVH-, n=22). No statistically significant difference was found between the two groups in terms of basic characteristics. The average 25(OH)D level was lower in LVH+ patients as compared to LVH- participants (18.7±8.9 vs. 31.6±9.4 ng/ml, p = 0.01), both in unadjusted and adjusted analyses. In unadjusted analysis, the average PTH level of LVH+ patients was higher than LVH- patients (85.3±14.2 vs. 56.9±30.8 pg/mL, P =0.03). However, in multivariate model, additional adjustment for 24-h systolic BP, this association was non-significant (p=0.12). Conclusion: Our results suggest that vitamin D deficiency could be related to development of left ventricular hypertrophy in hypertension. Left ventricular hyperthorphy is associated with higher parathyroid hormone, however the effect is mediated by blood pressure.

Further reduced systolic myocardial strain beyond left ventricular hypertrophy in hypertensive patients with suboptimal blood pressure control

Further reduced systolic myocardial strain beyond left ventricular hypertrophy in hypertensive patients with suboptimal blood pressure control

Determinants of Left Ventricular Hypertrophy in Hypertensive Patients: Identification of High-Risk Patients by Metabolic, Vascular, and Inflammatory Risk Factors

Left ventricular hypertrophy (LVH) is recognized as an independent predictor of cardiovascular morbidity and mortality in hypertensive patients. Thus, it is critical to understand the mechanisms underlying the development of LVH for formulation screening and treatment strategies. This study was designed to determine the association between echographically determined LVH measures and markers of inflammation, neurohormonal activity, glomerular function, oxidative stress, insulin resistance, and vascular endothelial function. In this study, 129 hypertensive subjects were evaluated for lipids, glucose, HbA1C, insulin, homeostasis model assessment-insulin resistance, C-reactive protein (CRP), urinary microalbumin, homocysteine, aldosterone, renin, and endothelin. LVH parameters including interventricular septum thickness, posterior wall thickness (PWT), and left ventricular mass index (LVMI) were assessed echographically. Serum aldosterone levels were significantly positively associated with left ventricular mass (LVM) and marginally positively associated with LVMI and PWT. Both LVM and LVMI were significantly elevated in subjects with high versus normal serum aldosterone levels (p = 0.018 for LVM and p = 0.050 for LVMI). Serum endothelin was positively associated with LVM and LVMI. In multiple linear regression analysis, aldosterone remained a significant predictor of LVM (standardized β = 0.229, p = 0.024), and endothelin a marginally significant predictor of LVM (standardized β = 0.178, p = 0.077). Among serum lipids, high-density lipoprotein cholesterol only had a significant inverse association with LVM and PWT. Homocysteine as well as CRP were significantly positively associated with LVM and LVMI in females. This study found that aldosterone and endothelin levels are the most important independent determinants of LVH in hypertensive subjects. These markers may be useful to identify asymptomatic hypertensive subjects at risk for heart failure.

Relationship between Nocturnal Blood Pressure and Left Ventricular Hypertrophy in Hypertensive Patients

Objective: Left ventricular hypertrophy (LVH) is the most common target organ damage in hypertension. However, the association of LVH and circadian rhythm of blood pressure (BP) is unknown. The objective of the present study was to explore the relationship between circadian rhythm of BP and LVH using ambulatory blood pressure monitoring (ABPM). Study design: A total of 325 untreated hypertensive patients were recruited. The patients were divided into two groups: hypertensive patients with LVH (n=121) and without LVH (n=204). Twenty-four-hour ABPM was performed in all the patients to collect the following parameters: 24-hour average systolic and diastolic pressure, daytime average systolic and diastolic pressure, nocturnal average systolic and diastolic pressure, and night to day BP ratio. The relationship between LVH and the various ABPM parameters was analyzed. Results: We found that the average nocturnal systolic blood pressure (SBP) in hypertensive patients with LVH was higher than that in hypertensive patients without LVH (145 ± 16.1 mmHg versus 136 ± 12.7 mmHg, P<0.05). The average night to day SBP ratio in hypertensive patients with LVH was also higher than that in hypertensive patients without LVH (0.93 ± 0.04 versus 0.86 ± 0.04, P<0.05). Multiple regression analysis indicate that the average nocturnal SBP and the night to day SBP ratio were associated with LVH (Odds ratio (OR) 1.67, 95% CI: 1.31-3.21; OR: 1.88, 95% CI: 1.56-3.78) by adjustment for traditional covariates. Conclusion: The average nocturnal SBP and the average night-day SBP ratio are independent risk factors of LVH in patients with hypertension.

Mean platelet volume and abnormal left ventricle geometric patterns in patients with untreated essential hypertension

Abnormal left ventricle (LV) geometric patterns are associated with a greater risk of hypertensive vascular complications. The mean platelet volume (MPV) reflects the platelet activity, and is associated with overall vascular mortality. Although association between MPV and LV hypertrophy in hypertensive patients has been investigated, relation between abnormal LV geometric patterns and MPV was not studied so far. The aim of this study is to investigate the relationship between MPV and abnormal LV geometric patterns in hypertensive patients. Measurements were obtained from 223 patients with untreated essential hypertension (Mean age = 52.1 ± 5.2 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodelling, EH; eccentric hypertrophy, CH; concentric hypertrophy) were determined according to the LV mass index (LVMI) and relative wall thickness (RWth). MPV, high sensitive C-reactive protein (hsCRP) and other biochemical markers were measured in all patients. The highest MPV values were determined in CH group compared with NG, CR and EH groups (p < 0.05, for all). MPV values were similar among the NG, CR and EH groups (p > 0.05, for all). MPV was associated with age, glucose, hsCRP, RWth, LVMI and LV geometry in bivariate analysis (p < 0.05, for all). Age (β = 0.110, p = 0.033), LVMI (β = 0.471, p < 0.001) and hsCRP (β = 0.525, p < 0.001) were independent predictors of high MPV in multiple linear regression analysis. The highest MPV values were observed in the CH group. This result may be associated with increased inflammation and LV hypertrophy in this geometric pattern.

The association of growth differentiation factor-15 with left ventricular hypertrophy in hypertensive patients.

Growth differentiation factor-15 (GDF-15) has been identified as an endogenous anti-hypertrophy effect. However, the association of plasma GDF-15 levels with left ventricular hypertrophy (LVH) in hypertension is poorly understood. We investigate the effect of plasma GDF-15 levels on left ventricular hypertrophy (LVH) in hypertension. We measured the plasma levels of GDF-15 in 299 untreated hypertensive patients which consisted of 99 with LVH and 200 without LVH using immunoradiometric assay. All subjects were examined by the ultrasonic cardiograph to determine Left ventricular (LV) internal diameters, septal thickness, and posterior wall thickness. The associations of GDF-15 with left ventricular mass index (LVMI), LV end-systolic and –diastolic diameters, LV wall thickness, and LV ejection fraction were evaluated. We found that plasma GDF-15 levels in hypertensive patients with LVH [median 1101, 25th–75th percentiles (879–1344) ng/L] were higher than that in hypertensive patients without LVH [median 516, 25th–75th percentiles (344–640) ng/L] (P<0.001). After adjustment for traditional covariates, plasma GDF-15 levels were independently related to LVMI (R2 = 0.53; β = 0.624, P<0.001), LV interventricular septal thickness (R2 = 0.23; β = 0.087, P<0.01) and LV posterior wall thickness (R2 = 0.26; β = 0.103, P<0.05). Our cross-sectional data on a hospital-based sample indicate that plasma GDF-15 levels are associated with LVH in hypertensive patients.

Would corrected QT dispersion predict left ventricular hypertrophy in hypertensive patients?

Aims. We explored whether QT corrected dispersion (QTcD) can identify left ventricular hypertrophy (LVH) in hypertensives. Methods. We enrolled 100 hypertensive patients (study group) and 30 normotensive subjects (control group). Echocardiography was performed to measure left ventricular mass and left ventricular mass index. Electrocardiogram was performed to measure QTcD. Results. LVH was present in 42 patients (42%) of the study group, none among controls. Hypertensive patients had significantly greater indices of LVH and QTcD compared with controls (p < 0.001 for all). Similarly, among hypertensive patients, those with LVH had a significantly greater QTcD compared with those without (p < 0.001). Pearson's correlation coefficient test demonstrated strongly positive correlations between QTcD and the indices of LVH (p < 0.001 for all). Analysis of the receiver operating characteristic curves identified 60 ms as the optimal cut-off value of QTcD that best predicts LVH in hypertensives. Using this value, QTcD was able to predict LVH with a sensitivity of 92.9% and specificity 98.2%. Conclusions. QTcD is significantly increased in hypertensive patients with LVH compared with those without, being strongly correlated with the indices of LVH. A QTcD cut-off value of 60 ms predicted LVH in hypertensive patients with a high sensitivity and specificity.

Blood pressure but not regional pulse wave velocity is associated with left ventricular hypertrophy in hypertensive patients

Blood pressure but not regional pulse wave velocity is associated with left ventricular hypertrophy in hypertensive patients

Direct measurement of radial strain in the inner-half layer of the left ventricular wall in hypertensive patients

Two-dimensional speckle tracking echocardiography (2D-STE) is a novel technology that directly measures regional left ventricular (LV) wall contraction. This study aimed to directly measure inner-layer thickening (radial strain) of the LV using 2D-STE, and to examine the relationship between radial strain and the degree of hypertrophy. The study enrolled 63 untreated hypertensive patients with normal geometry (N group, n=32) or concentric hypertrophy (CH group, n=31), classified according to LV mass index (LVMI) and relative wall thickness (RWT). Thirty normotensive subjects (C group, n=30) served as controls. Radial strain (ɛ) in the inner half (ɛi) and all layers of the LV wall (ɛa) were calculated from the LV short-axis view by 2D-STE. LV ejection fraction did not differ significantly among the groups. However, ɛi and ɛa were significantly lower in the CH group compared with the C and N groups (p<0.01). A ratio of ɛi to ɛa was significantly lower in the CH group compared with the C and N groups (p<0.01). A multivariate regression model that included midwall fractional shortening, E/e', LVMI, RWT, and LV ejection fraction showed that LVMI (p=0.002) and RWT (p=0.014) were independent predictors (R(2)=0.59) of ɛi. Radial strain in the inner half layer of the LV wall decreases in parallel with the degrees of LV concentricity and hypertrophy in hypertensive patients. Radial strain in the inner half layer may identify subtle systolic dysfunction even in hypertensive patients with preserved LV chamber function.

Differences in Left Ventricular Diastolic Dysfunction between Eccentric and Concentric Left Ventricular Hypertrophy in Hypertensive Patients with Preserved Systolic Function

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) (the E/A ratio), peak early diastolic mitral annular velocity (e') and the E/e' ratio. Although LVMI, E/A and e' did not differ between the two groups, E/e' was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.

Left ventricular hypertrophy in hypertensive patients with different ambulatory monitoring daily pattern

The aim of the present study was to try to identify which parameters of blood pressure (BP) ambulatory monitoring are better related to the presence of left ventricular hypertrophy in hypertensives. Fifty-six ambulatory hypertensive patients were investigated. Patients were subdivided into two groups of comparable casual and twenty-four-hour ambulatory pressure but with different nighttime decrements of the mean BP (respectively>10%, n=29, and ≤10%, n=27). When all the patients were considered, no significant correlation between left ventricular mass index (LVMI) and casual pressure values was found. On the contrary significant relationships between LVMI and systolic ambulatory twenty-four-hour (p<0.01), daytime (p<0.01), and nighttime (p<0.001) pressures, but not with diastolic pressures, were found. The interventricular septum (P<0.03) and the LVMI (P<0.03) respectively measured and calculated by echocardiography, were significantly larger in patients with limited pressure fall at nighttime. The extent of BP fall at nighttime assessed by ambulatory monitoring seems, therefore, to permit identification of hypertensive patients at higher cardiovascular risk.

Treatment of Heart Failure With Normal Ejection Fraction

Opinion StatementHeart failure (HF) is a major cause of mortality and morbidity and one of the most frequent reasons for hospital admission in the United States and Europe. Currently, more than 50% of HF patients have a normal (N) left ventricular (LV) ejection fraction (EF) (LVEF >50%). The main pathophysiologic processes involved in HFNEF are increased LV stiffness and abnormal relaxation, resulting in impaired LV filling. Hypertension and myocardial ischemia are the most common causes of HFNEF. Precipitating factors include volume overload, tachycardia, physical exercise, systemic stressors (such as fever and infection), arrhythmia, increased salt intake, and use of nonsteroidal anti-inflammatory drugs. There is little evidence to guide treatment, as previously HFNEF patients have been excluded from clinical trials on the basis of a normal LVEF. Survival improved over time in patients with reduced (R) EF (HFREF) (LVEF <40%), reflecting the beneficial effects of treatment in this phenotype. However, survival did not improve for HFNEF patients. The approach to the treatment of HFNEF patients should focus on reducing LV filling pressure, controlling hypertension, modifying ischemia, and improving LV relaxation. Therefore, diuretics are suitable for HFNEF patients to reduce ventricular filling pressure. Hypertension can be treated by using multiple agents if necessary. Drugs of particular interest and recommended to treat hypertension are calcium channel blockers (CCBs) and antagonists of the renin-angiotensin-aldosterone system, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and aldosterone antagonists. Ischemic heart disease can be treated with antiplatelet therapy, anticoagulants, and β-blockers. Heart rate control in atrial fibrillation can be achieved with β-blockers and digoxin. Finally, ACE inhibitors and ARBs could potentially decrease LV hypertrophy in hypertensive patients with HFNEF.

Evaluation of left ventricular hypertrophy in hypertensive patients with echocardiographic myocardial videodensitometry normalized by displacement

Left ventricular hypertrophy (LVH) is an important predictor of cardiovascular morbidity and mortality. To investigate the feasibility of the myocardial grayscale intensity (GI) normalized by displacement (d) to discriminate between healthy and hypertrophic myocardium in hypertensive patients, sixty hypertensive patients and sixty age and sex-matched healthy volunteers were involved in this study. The peak d and the maximal GI [GI(max)] and minimal GI [GI(min)] for the middle interventricular septal (IVS) and the middle posterior wall (PW) at the level of papillary muscle were obtained from the standard parasternal long axis views using tissue tracking (TT) and videodensitometric analysis, respectively. The GI and the cyclic variation of GI (CVGI) normalized by d were calculated. The results showed that the d both for IVS and PW, the amplitude of CVGI for IVS in hypertensive patients with LVH were smaller than the ones without LVH and the normal subjects. But, the CVGI/d both for IVS and PW in hypertensive patients with LVH were all greater than the ones without LVH and the normal subjects. Moreover, the parameter, CVGI/d correlated positively with left ventricular mass index (LVMI). So, the method employed in this study, videodensitometric analysis in combination with TT allow objective and accurate determination of LVH and CVGI/d is a sensitive indicator for hypertensive patients with LVH.

Prevalence and severity of echocardiographic left ventricular hypertrophy in hypertensive patients in clinical practice

Background and aim. The prevalence of left ventricular hypertrophy (LVH) in human hypertension has been mostly documented in population-based samples and selected hypertensive cohorts. Rather scant data are available from clinical practice. Thus, we examined the prevalence of LVH in a large group of hypertensive patients referred by general practitioners to a routine echocardiographic examination. Methods. A total of 2249 hypertensive subjects (mean age 62 years, 52.3% men, 84.5% treated) referred by their practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive early cardiac damage were included in the study. LVH was defined as left ventricular mass (A) ≥ 225/163 g, (B) ≥ 116/96 g/m2, (C) ≥ 49/45 g/m2.7 in men/women, respectively; LVH was graded as mild, moderate and severe according to Lang's report. Results. Overall, patients with LVH were 58%, 58% and 65% by criteria A, B and C, respectively. LVH was mild in 33% (A), 36% (B) and 29% (C), moderate in 31% (A), 28% (B) and 27% (C), and severe in 36% (A), 36% (B) and 44% (C). Conclusions. Data provided by this multicentre nationwide survey support the view that, despite therapeutic interventions, LVH remains a highly frequent phenotype in human hypertension and that severe LVH is present in a large fraction of hypertensives.

Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation

Persistence and development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of atrial fibrillation compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via greater left atrial enlargement (LAE) in patients with new and persistent ECG LVH. Baseline and third year ECG LVH and left atrial systolic diameter were examined in 663 patients in the Losartan Intervention For Endpoint reduction in hypertension echocardiographic substudy who were in sinus rhythm at baseline and had no history of atrial fibrillation. Left atrial systolic diameter was measured and considered enlarged if more than 3.8 cm in women or more than 4.2 cm in men. Cornell product LVH above 2440 mm-ms was considered consistent with LVH. After 3 years follow-up, 238 patients (35.9%) had continued absence of Cornell product LVH, 156 (23.5%) had regression of LVH, 236 (35.6%) had persistent LVH and 33 patients (5.0%) developed new ECG LVH. Compared with third year mean left atrial systolic dimension and prevalence of LAE in patients with continued absence of LVH (3.62+/-0.52 cm, 12.6%), there were step-wise increases in patients with regression of LVH (3.71+/-0.49 cm, 20.5%), persistence of LVH (3.82+/-0.57 cm, 32.2%) and development of new ECG LVH (3.91+/-0.42 cm, 36.4%, both P<0.001). After controlling for differences in age, sex, baseline SBP, BMI and Sokolow-Lyon voltage, randomized treatment allocation, change in DBP and SBP between baseline and third year and for isovolumic relaxation time and presence of an abnormal mitral E/A ratio at baseline and third year, the odds of having LAE were significantly increased in patients with persistent LVH (odds ratio 1.8, 95% confidence interval 1.1-3.2, P=0.043) or new LVH (odds ratio 3.1, 95% confidence interval 1.3-7.7, P=0.016), but not in patients with regression of Cornell product LVH (odds ratio 1.1, 95% confidence interval 0.6-2.0, P=0.860). Persistence or development of new ECG LVH during antihypertensive therapy are associated with an increased risk of LAE after 3-year follow-up, whereas regression of ECG LVH is not associated with an increased risk of LAE. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing atrial fibrillation.