Left Ventricular Hypertrophy In Hypertensive Patients Research Articles

Association between left ventricular hypertrophy and the peak times of the R and P waves in hypertensive patients

Purpose: This study aimed to investigate the relationship between left ventricular hypertrophy (LVH), assessed by echocardiographic left ventricular mass index (LVMI), and electrocardiographically evaluated R wave peak time (RWPT) and P wave peak time (PWPT) in hypertensive patients. Materials and Methods: A cross-sectional study was conducted involving 100 hypertensive patients, excluding those with specific medical conditions. Clinical and demographic data were collected, and electrocardiographic and echocardiographic examinations were performed. RWPT and PWPT were assessed along with other parameters. Results: LVH was present in 33 out of 100 patients. Patients with LVH exhibited significantly higher RWPT (45.6 ± 4.9 vs. 35.0 ± 5.5) and PWPT (55.5 ± 15.8 vs. 49.1 ± 12.5) compared to those without LVH. Additionally, LVH patients showed increased left atrium anteroposterior diameter, and prolonged deceleration time. QRS fragmentation was more common in the LVH group. Conclusion: The study highlights the association between electrocardiographic parameters (RWPT and PWPT) and LVH in hypertensive patients. These findings underscore the potential utility of electrocardiogram as a non-invasive tool for LVH assessment in clinical practice in hypertensive patients, aiding in risk stratification and therapeutic decision-making.

Myocardial work alterations with progressive left ventricular hypertrophy in patients with hypertension.

Left ventricular (LV) hypertrophy (LVH) is frequently observed in patients with hypertension (HTN). LV myocardial work (MW) has recently emerged as a non-invasive method to assess systolic myocardial deformation relative to afterload conditions. The authors investigated the characteristics of myocardial work with different degrees of LVH in HTN patients. From December 2020 to February 2024, 255 HTN patients and 26 healthy controls undergoing transthoracic echocardiography were included in the current study. Hypertension patients were divided into quintile groups based on left ventricular mass index (LVMI), for the first to fourth LVMI quantiles, global work index (GWI) and global constructive work (GCW) were higher compared to the control group, but the difference was not statistically significant. In the sixth LVMI quantile, GWI and GCW showed a significant decrease. The restricted cubic splines showed that both GWI and GCW exhibited an inverted U-shaped relationship with LVMI. A LVMI of >151.39g/m2 could accurately predict reduction both in GWI and GCW (Sensitivity: 0.78, Specificity: 0.89, AUC: 0.90, P <.001; Sensitivity: 0.81, Specificity: 0.92, AUC: 0.92, P <.001, respectively). As LVH progressed in HTN patients, both GWI and GCW initially demonstrated an increase, followed by a subsequent decrease. Myocardial work provides additional insights into assessment of cardiac function in HTN patients.

Abstract 18294: The Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: The effect of intensive blood pressure (BP) lowering on cardiac remodeling remains uncertain, with emerging evidence suggesting that it can prevent the development of left ventricular hypertrophy (LVH) in patients with hypertension (HTN). We aim to investigate the effect of intensive BP lowering on LVH and cardiovascular disease (CVD) incidence in HTN patients. Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through June 8 th , 2023. We used the random-effect model to pool dichotomous data using risk ratio (RR) and hazard ratio (HR), with a 95% confidence interval (CI). Trial sequential analysis (TSA) was performed to weigh type I and II errors, estimating if the effect is large enough to be unaffected by further studies. Results: We included four RCTs with a total of 20,747 patients. Two RCTs investigated an intensive target of &lt; 120 mmHg, and another two investigated &lt;130 mmHg. Intensive BP lowering was associated with a decreased risk of LVH incidence (RR: 0.66, with 95% CI [0.56 - 0.77]). Our TSA revealed that the cumulative Z-curve consistently crossed the TSA boundary, indicating a statistically significant effect, signifying that the available evidence has reached a predefined threshold for statistical significance, providing robust evidence. Also, intensive BP lowering was associated with a decreased risk of CVD (HR: 0.71, with 95% CI [0.60 - 0.85]). Conclusion: Intensive BP lowering protects against LVH in HTN patients. TSA suggests that additional RCTs may not be necessary to establish the efficacy of intensive BP lowering on LVH. Also, intensive BP lowering was associated with decreased CVD incidence; however, LVH did not explain this effect in the included RCTs. Therefore, further research is warranted to explore possible mechanisms of decreasing CVD with intensive BP lowering in HTN patients.

Polymorphic variants at NDUFC2, encoding a mitochondrial complex I subunit, associate with cardiac hypertrophy in human hypertension

BackgroundA dysfunction of NADH dehydrogenase, the mitochondrial Complex I (CI), associated with the development of left ventricular hypertrophy (LVH) in previous experimental studies. A deficiency of Ndufc2 (subunit of CI) impairs CI activity causing severe mitochondrial dysfunction. The T allele at NDUFC2/rs11237379 variant associates with reduced gene expression and impaired mitochondrial function. The present study tested the association of both NDUFC2/rs11237379 and NDUFC2/rs641836 variants with LVH in hypertensive patients. In vitro studies explored the impact of reduced Ndufc2 expression in isolated cardiomyocytes.MethodsTwo-hundred-forty-six subjects (147 male, 59.7%), with a mean age of 59 ± 15 years, were included for the genetic association analysis. Ndufc2 silencing was performed in both H9c2 and rat primary cardiomyocytes to explore the hypertrophy development and the underlying signaling pathway.ResultsThe TT genotype at NDUFC2/rs11237379 associated with significantly reduced gene expression. Multivariate analysis revealed that patients carrying this genotype showed significant differences for septal thickness (p = 0.07), posterior wall thickness (p = 0.008), RWT (p = 0.021), LV mass/BSA (p = 0.03), compared to subjects carrying either CC or CT genotypes. Patients carrying the A allele at NDUFC2/rs641836 showed significant differences for septal thickness (p = 0.017), posterior wall thickness (p = 0.011), LV mass (p = 0.003), LV mass/BSA (p = 0.002) and LV mass/height2.7(p = 0.010) after adjustment for covariates. In-vitro, the Ndufc2 deficiency-dependent mitochondrial dysfunction caused cardiomyocyte hypertrophy, pointing to SIRT3-AMPK-AKT-MnSOD as a major underlying signaling pathway.ConclusionsWe demonstrated for the first time a significant association of NDUFC2 variants with LVH in human hypertension and highlight a key role of Ndufc2 deficiency-dependent CI mitochondrial dysfunction on increased susceptibility to cardiac hypertrophy development.

Association of depression with hypertensive left ventricular hypertrophy in age, sex, and education level-specific differences.

Previous studies have shown that hypertension and depression are associated with worse cardiovascular outcomes and reduced quality of life. Left ventricular hypertrophy (LVH) is strongly linked to increased mortality and cardiovascular disease, and depression may be one of the key factors contributing to hypertensive LVH. The authors consecutively enrolled 353 patients with uncomplicated hypertension between November 2017 and May 2021. All participants completed the Hamilton Depression Scale (HAM-D) to assess their depression status, with depression defined as a HAM-D score of 20 or higher. Linear regression analysis revealed a positive association between HAM-D and LVMI (adjusted β, 1.51, 95% CI, 1.19-1.83, p<.001). Logistic regression models showed that individuals with hypertension and depression had a higher risk of LVH than those with hypertension alone (adjusted OR, 2.51, 95% CI, 1.14-5.52, p=.022). The association between depression and LVH significantly interacted with age, sex, education levels, but not BMI and household income. Following age, sex, and education levels stratification, an independent association of depression and LVH was observed only in age<60 years (age<60 years: OR, 7.36, 95% CI, 2.25-24.13, p<.001), male (male: OR, 16.16, 95% CI, 3.80-68.73, p<.001), and higher education levels (high school and above: OR, 11.09, 95% CI, 2.91-42.22, p<.001). Our findings suggest that depression is a significant risk factor for LVH in hypertensive patients, particularly in those who are under 60 years of age, male, and have higher education levels.

In search of heart barometer—advantage of left atrial dimension over electrocardiographic indices of left ventricular hypertrophy in arterial hypertension

Aim: Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH. Methods: The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared. Results: Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P &lt; 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P &lt; 0.0001, showing an even stronger correlation in women—rho = 0.8 (P &lt; 0.0001) vs. rho = 0.65 (P &lt; 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R2 = 0.52, P &lt; 0.0001. Conclusions: LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.

Deficiency of Tregs in hypertension-associated left ventricular hypertrophy.

Left ventricular hypertrophy (LVH) is the most common target organ damage in hypertension. Abnormal numbers or functions of CD4+ CD25+ Foxp3+ regulatory T lymphocytes (Tregs) can cause immune disorders, which participates in LVH. This study aimed to explore the role of Tregs in LVH by investigating circulating Tregs and associated cytokine levels in hypertensive patients with or without LVH. Blood samples were collected from 83 hypertensive patients without LVH (essential hypertension group, EH), 91 hypertensive patients with LVH (left ventricular hypertrophy group, LVH), and 69 normotensive controls without LVH (control group, CG). Tregs and cytokines were measured by flow cytometry and enzyme-linked immunosorbent assays. We found that circulating Tregs were significantly lower in hypertensive patients than in CG subjects. It was lower in LVH than in EH patients. No correlation between blood pressure regulation and Tregs was found in EH or LVH patients. Furthermore, Tregs in older females were lower than those in older males among LVH patients. Additionally, serum interleukin-10 (IL-10) and transforming growth factor beta 1 (TGFβ1) decreased in hypertensive patients, and interleukin-6 (IL-6) increased in LVH patients. Tregs were negatively correlated with creatine kinase, low-density lipoprotein cholesterol, apoprotein B, high-sensitivity C-reactive protein, and left ventricular mass index (LVMI) values. In general, our study demonstrates significantly decreased circulating Tregs in hypertensive LVH patients. Decreased circulating Tregs in LVH is independent of blood pressure regulation. IL-6, IL-10, and TGF-β1 are related with LVH in hypertension.

Efekat metaboličkog sindroma na incidencu i stepen hipertrofije miokarda leve komore kod hipertenzivnih pacijenata

Metabolic syndrome (MetS) is characterized by the simultaneous presence of obesity, hypertension, dyslipidemia and hyperglycemia in an individual, which leads to an increased risk of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) is thickening of the heart muscle wall -hypertrophy of cardiomyocytes in concentric and/or elongation of cardiomyocytes and hyperplasia of connective tissue in eccentric hypertrophy with the participation of hemodynamic and non-hemodynamic factors (genetics, stress, other external factors). MetS, which essentially includesinsulin resistance, hyperinsulinemia, and hyperglycemia, alters myocardial metabolism and promotes myocardial inflammation, fibrosis, hypertrophy, and left ventricular remodeling. OBJECTIVE: To determine the impact of MetS, that is, obesity to the incidence and degree of severity of LVH in hypertensive patients with metabolic syndrome in comparison with the control group -hypertensive patients without metabolic syndrome. PATIENTS AND METHODS: Consecutive patients of the Office of Internal Medicine "Dr. Bastać" were examined, a total of 55 patients with hypertension, who were divided into two groups: the first group with MetS, 22 people, average age 56±8.5 years with BMI&gt;30kg /m 2 and waist circumference more than 80 cm for women and &gt;94 cm for men, the second control group without MetS-33 people, average age 52±14 years, with BMI&lt;30kg/m 2 . Echocardiography was done for all subjects on a Power Vision 6000 Toshiba echo camera with standard echocardiographic measurements in the M, B and Doppler technique, and the mass of the left ventricular myocardium was determined for them using the Devereux formula. RESULTS: The prevalence of LVH in group 1 with metabolic syndrome (MetS) was 64%, while in the control group without (MetS) it was 36%. There was a statistically significantly higher number of patients with LVH in hypertension with MetS compared to hypertensive patients of the control group without MetS (X2, p=0.027). In the group of hypertensive patients with MetS, the degree of severity of myocardial hypertrophy, that is, the myocardial mass , was statistically significantly higher compared to the control group (respectively 302±84g versus 224±89g, p=0.0002). Arterial pressure values were higher for both systolic and diastolic blood pressure 168/106 mmHg in hypertensive patients with MetS, but did not reach statistical significance in relation to blood pressure values in hypertensive patients without MetS (156/95 mmHg, p=0.16). CONCLUSION. Patients with metabolic syndrome and hypertension have a statistically significantly higher prevalence of left ventricular myocardial hypertrophy and a highly statistically significant degree of left ventricular hypertrophy compared to the control group of hypertensive individuals without MetS. Given that mean values of arterial pressure do not differ between groups, it can be concluded that non-hemodynamic factors for the development of LVH have an important role in the induction of a more severe degree of LVH in hypertensive patients with metabolic syndrome.

Evaluation of myocardial work in patients with hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy based on non-invasive pressure-strain loops.

BackgroundThe capacity to distinguish hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) based on morphological features obtained by conventional echocardiography is limited. We investigated the global myocardial work of the left ventricle in two types of hypertrophies using the non-invasive myocardial work index (NMWI).MethodsConventional echocardiography was performed on 107 subjects with preserved left ventricular ejection fraction (LVEF ≥ 50%), who comprised patients with HCM (n = 40), H-LVH (n = 35), and healthy people with normal blood pressure and left ventricular structure (n = 32). Except for the conventional echocardiographic parameters, the left ventricular myocardial work parameters based on pressure-strain loops, including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were evaluated in three groups. Multivariate discriminant analysis and receiver operating characteristic (ROC) curve were used to evaluate the incremental value of NMWI for distinguishing HCM from H-LVH.ResultsCompared to the control group, GWI and GCW were significantly lower in HCM patients (P < 0.05), whereas GWI was significantly higher in H-LVH patients. GWW was higher and GWE was significantly decreased in both HCM and H-LVH patients than in the control group (P < 0.05). Multivariate discriminant analysis and ROC curve revealed that the inter-ventricular septum thickness (IVST)/left ventricular posterior wall thickness (LVPWT) and GCW were each able to distinguish HCM from H-LVH. The combination of IVST/LVPWT and GCW discriminated HCM and H-LVH with a higher predictive accuracy of 94.7%.ConclusionNMWI may provide additional information in evaluating the myocardial function in patients with HCM and H-LVH. Myocardial work combined with conventional echocardiography could improve the clinical diagnostic accuracy of distinguishing HCM and H-LVH.

ASSOCIATION OF NDUFC2 POLYMORPHIC VARIANTS WITH LEFT VENTRICULAR HYPERTROPHY IN HUMAN HYPERTENSION

Objective: Previous experimental studies showed that a dysfunction of the NADH dehydrogenase (ubiquinone), the mitochondrial Complex I (CI), is associated with the development of left ventricular hypertrophy (LVH). A deficiency of Ndufc2 (a subunit of CI) impairs CI activity and causes severe mitochondrial dysfunction. The NDUFC2/rs11237379 polymorphic variant is associated with reduced gene expression and impaired mitochondrial function, contributing to increased susceptibility to vascular diseases. We examined the association of NDUFC2/rs11237379 and another NDUFC2 polymorphic variant (rs641836) with the development of LVH in hypertensive patients. Design and method: Two-hundred-fourty-six hypertensive subjects (147 male, 59.7%) with a mean age of 59 ± 15 years were studied. Seventy-nine individuals (32%) presented LVH. Results: The association analysis for both SNPs showed that hypertensive patients carrying the TT genotype at the NDUFC2/rs11237379 had a significant increase of echocardiographically assessed septal thickness (p = 0.001), posterior wall thickness (p = 0.003), relative wall thickness (RWT) (p = 0.01), LV mass/ body surface area (BSA) (p = 0.012) and LV mass/height2.(p = 0.0033) compared to subjects carrying either CC or CT genotypes. To better dissect the genetic effect, a covariate ANOVA was performed for each cardiac variable, considering age, gender, body mass index (BMI), office blood pressure (BP), antihypertensive treatment with a combination of 2 or more drugs and the number of BP-lowering agents as covariates. The adjustment for covariates revealed significant differences for septal thickness (p = 0.07), posterior wall thickness (p = 0.008), RWT (p = 0.021), LV mass/BSA (p = 0.03). With regard to NDUFC2/rs641836, hypertensive subjects carrying the mutant A allele had a significant increase of septal thickness (p = 0.001), posterior wall thickness (p = 0.001), RWT (p = 0.005), LV mass (p = 0.001), LV mass/BSA(p = 0.001), LV mass/height2.7(p = 0.002) compared to wild-type homozygotes. After adjustment for covariates, the results were significant for septal thickness (p = 0.017), posterior wall thickness (p = 0.011), LV mass (p = 0.003), LV mass/BSA (p = 0.002) and LV mass/height2.7(p = 0.010). Conclusions: Our results demonstrate for the first time a significant association of NDUFC2 variants with LVH in hypertensives and highlight a novel role of CI dependent mitochondrial dysfunction on increased susceptibility to cardiac damage in human hypertension. This study paves the way of a new pathophysiological mechanism of LVH which may lead to new clinical strategies.

English

BACKGROUND Essential hypertension represents 90 – 95 % of all instances of hypertension. Microalbuminuria was observed to be related to increased chances of coronary artery disease even in patients already on treatment for hypertension. Microalbuminuria was identified with left ventricular hypertrophy recommending equal heart harm and albuminuria in hypertensive patients. However, the pervasiveness of hypertension is high in India, the connection between microalbuminuria and target organ damage in hypertension isn't well studied. This study intended to decide the extent of microalbuminuria in non-diabetic patients with essential hypertension and concentrate on the relationship of microalbuminuria with the worsening of left ventricular hypertrophy (LVH) and hypertensive retinopathy (HRP). METHODS This was a hospital-based cross-sectional analysis conducted in a hospital from January 2019 to September 2019. Information was gathered from 93 patients fulfilling the consideration standards utilizing a formerly planned semi-structured questionnaire. Urine microalbumin level, echocardiography, ECG and fundus assessment were done. The study variables were recorded and dissected utilizing SPSS software. RESULTS The mean age of the group populace was 55 + 8.89 years. Microalbuminuria was present in 68 %. There was a measurably critical relationship between the age group studied and the predominance of microalbuminuria. There was a huge factual affiliation between the presence of microalbuminuria and LVH in hypertensive patients (P &lt; 0.0001), with microalbuminuria and HRP (P &lt; 0.0001) and with microalbuminuria and long-standing hypertensives (P &lt; 0.0001). CONCLUSIONS The larger part of microalbuminuria positives was found disseminated among higher ages. There was a positive relationship among patients with microalbuminuria and LVH, with retinopathy in hypertensive patients, with grade 2 hypertension and with long-standing hypertensives. KEY WORDS Hypertension, Microalbuminuria, LVH, Hypertensive Retinopathy

The high normal ankle brachial index is associated with left ventricular hypertrophy in hypertension patients among the Han Chinese

Left ventricular hypertrophy (LVH) is the most common target organs damage in the hypertension patients. Abnormal low (≤0.9) or high (≥1.40) ankle brachial index (ABI) are associated with an increased risk of cardiovascular events. However, the relationships between a high ABI in the normal range (0.9–1.4) and LVH in Han Chinese hypertension are not entirely elucidated. This study included 3953 hypertension patients aged 40–75 years among Han Chinese. Hypertension was defined as systolic blood pressure≥140 mm Hg, diastolic blood pressure≥90 mm Hg, or history of antihypertensive drug use. Left ventricular mass (LVM) was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of LVM ≥49.2 g/m2.7 for men and 46.7 g/m2.7 for women. Our study suggested that the ABI was higher in patients with LVH than in those without (1.13±0.11, 1.11±0.11, p < 0.001). The prevalence of LVH in patients with the lowest (0.9 < ABI≤1.03), second (1.04≤ABI≤1.11), the third (1.12≤ABI≤1.20), and the highest quartile (1.21≤ABI < 1.40) of ABI was 37.2%, 38.2%, 45.5%, 45.7%, respectively. Logistic regression analysis suggested that the highest and third quartile of ABI were significantly associated with increased LVH risk (multivariate‐adjusted OR of highest group:1.83; third group:1.61). The association of ABI at second quartile with LVH was nonsignificant. Similar results were observed in less than 60 years and without coronary heart disease or diabetes group. Our observations in Chinese patients with hypertension indicated high ABI may be an important risk factor for LVH in hypertension patients among Han Chinese, even in the normal range.

VALUE OF DIFFERENT ECHOCARDIOGRAPHIC MODALITIES IN THE ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH TYPE II DIABETES MELLITUS

Background: Left ventricular hypertrophy (LVH) is the response of myocytes to various stimuli leading to myocytes’ hypertrophy, which occurs as a compensatory response to increased after-load. It is defined as an increase in LV mass assessed by postmortem measurements, electrocardiographic (ECG), echocardiographic and cardiovascular magnetic resonance (CMR) criteria. Objective: To investigate the reproducibility of different echocardiographic modalities in the assessment of LVH in hypertensive patients and patients with type II DM in comparison to the golden standard CMR measurements. Patients and Methods: We prospectively investigated 40 patients with LVH, 20 patients being hypertensive and diabetic, 20 patients being diabetic only and 20 healthy control subjects (normal ventricular function and ECG and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, LV mass and volumes were analyzed. Results: The comparison between new echocardiographic techniques and CMR showed that the assessments of LV volumes/LVEF by echocardiography and CMR have good correlations. However, the inter-technique agreement of absolute LV volumes revealed considerable differences, with significant underestimation of volumes and LVEF with respect to CMR. The LV mass was less in patients assessed by different algorithms of 2D echo rather than 3D echo and CMR, correlated positively with EDV and ESV. Conclusion: 3D echocardiography attains more solid results in patients diagnosed having LVH by 2D echocardiography. CMR would be preferable for research and specific clinical conditions requiring higher accuracy and reproducibility.

Comparative efficacy of different types of antihypertensive drugs in reversing left ventricular hypertrophy as determined with echocardiography in hypertensive patients: A protocol for systematic review and meta-analysis.

Background:Reversing left ventricular hypertrophy (LVH) can reduce the incidence of adverse cardiovascular events. The lack of direct comparison between different antihypertensive drugs cannot evaluate the superiority-inferiority differentiation of different antihypertensive drugs in reversing LVH. Therefore, the objective of this protocol for systematic review and meta-analysis was to compare the efficacy of different types of antihypertensive drugs in reversing LVH in hypertensive patients.Methods:This meta-analysis was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement guidelines. Studies were identified through systematic searches in June 2021 with no restrictions on date and time, language, and publication status using the following bibliographic databases: Embase, Medline, PubMed, Web of Science, Science Direct, and the Cochrane Library. The risk of bias assessment of the included studies was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom).Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:We hypothesized that the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in antihypertensive therapy could achieve better efficacy in reversing LVH in hypertensive patients.

28. USEFULNESS OF NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) AS A PREDICTOR FOR LEFT VENTRICULAR HYPERTROPHY (LVH) IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSES

Background: Left ventricular hypertrophy (LVH) is a common pathological change in hypertension, which is a marker for cardiovascular events and mortality. Inflammation as well as ischemia play significant roles and are the leading pathways in left ventricular remodeling. Thus, neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, was suggested to be predictive of LVH in hypertensive patients. Objective: Our aim was to review all studies that assessed the value of NLR in predicting LVH in hypertension. Methods: We performed a systematic literature search on the topic from several electronic databases (PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar) from inception to January 2021. The standardized mean difference (SMD) with 95% confidence interval (CI) were estimated and pooled to investigate the effect sizes. Results: Meta-analysis of two studies showed that increase in NLR was associated with higher risk of developing LVH in patients with hypertension (SMD = 0.68, 95% confidence interval [CI] = 0.12–1.25, Z = 2.36, P = 0.02) compared with control group. Additionally, further subgroup analyses of LVH categorization stratified by Ganau's classification showed significant higher NLR value in eccentric LVH subgroup (SMD = 1.22, 95% CI = 0.08–2.36, Z = 2.11, P = 0.04) although no significant difference was observed in other three subgroups. Conclusion: In this current meta-analysis, we concluded that NLR is a reliable and inexpensive biomarker to help determine risk of developing LVH in patients with hypertension.

Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients

Introduction: The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. Methods: The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21–76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54–75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. Results: Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (r = 0.602, p < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (R² = 0.362; adjusted R² = 0.329, p < 0.001) were heart rate (β = −0.568 ± 0.149, p < 0.001), central SBP (β = 0.290 ± 0.100, p = 0.005), and aortic root diameter (β = 1.355 ± 0.344, p = 0.001). Age (β = −0.025 ± 0.124, p = 0.841) and the central AIx (β = 0.120 ± 0.131, p = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m² in men or >108 g/m² in women) was statistically significant in men (0.875, p < 0.001) but not in women (0.622, p = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. Conclusions: AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.

Comparative efficacy of different types of antihypertensive drugs in reversing left ventricular hypertrophy as determined with echocardiography in hypertensive patients: A network meta-analysis of randomized controlled trials.

Reversing left ventricular hypertrophy (LVH) can reduce the incidence of adverse cardiovascular events. However, there is no clear superiority-inferiority differentiation between angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (BB), calcium channel blockers (CCB), and diuretics in reversing LVH in hypertensive patients. To provide further evidence for choosing the optimal antihypertensive drug for improving LVH, we performed a network meta-analysis of randomized controlled trials (RCTs) based on the Cochrane library database, Embase, and Pubmed, and identified 49 studies involving 5402 patients that were eligible for inclusion. It was found that ARB could improve LVH in hypertensive patients more effectively than CCB (MD -4.07, 95%CI -8.03 to -0.24) and BB (MD -4.57, 95%CI -8.07 to -1.12). Matched comparison of renin-angiotensin system inhibitors (RASi) showed that the effect of ACEI in reducing left ventricular mass index (LVMi) was not effective as that of ARB (MD -3.72, 95%CI -7.52 to -0.11). The surface under the cumulative ranking for each intervention indicated that the use of ARB was more effective among the different types of antihypertensive drugs (97%). This network meta-analysis revealed that the use of ARB in antihypertensive therapy could achieve better efficacy in reversing LVH in hypertensive patients.

The associations of circulating microRNA-133a with parameters of hypertension heart disease in patients with arterial hypertension and obesity

Abstract Introduction Blood pressure (BP) elevation leads to chronical increasing left ventricular (LV) overload, LV hypertrophy (LVH), impaired LV relaxation, development of LV diastolic dysfunction (DD), left atrial (LA) enlargement, which result in development of hypertension heart disease (HDD), increased risk of atrial fibrillation and heart failure. MicroRNA-133a is one the epigenetics factor, which has cardioprotective properties, but its role in the development of HHD in hypertension patients with obesity is not well understood. Purpose The aim of the study was to investigate the circulating microRNA-133a levels in patients with hypertension and obesity and to define its associations with components of HHD. Methods The study involved 82 patients with arterial hypertension grades 2–3 and obesity (44 men and 38 women) aged 43 to 70. All patients were separate in two groups: 45 patients with HHD (main group) and 37 patients without HHD (comparison group). The control group consisted of 21 practically healthy individuals of comparable gender and age. The HHD was defined as LVH in hypertension patients with/without LV DD. The LVH was determined according to the 2018 ESC/ESH guidelines. The LV DD was determined according to the 2016 ASE/EACVI recommendations. Obesity was diagnosed at body mass index ≥30 kg/m2. Circulating plasma microRNA-133a levels were obtained by polymerase chain reaction using the CFX96 Touch System, “TaqMan microRNA Assay” and “TaqMan® Universal PCR Master Mix” reagent kits. Results The levels of microRNA-133a in main group were significantly lower than in comparison group and control group (0.133 [0.099; 0.184] vs 0.238 [0.155; 0.410], p&amp;lt;0.05 and 0.382 [0.198; 0.474]), p&amp;lt;0.05). In the main group 23 patients had LV DD and 25 patients had normal LV diastolic function. In patients with LV DD the levels of circulating plasma microRNA-133a were significantly lower than in patients with normal LV diastolic function (0.094 [0.067; 0.147] vs 0.152 [0.092; 0.189]), p&amp;lt;0.05). In the main group there was a statistically significant negative correlation between microRNA-133a levels and LV mass index (R=−0.37, p&amp;lt;0.01) and no significant correlation with ejection fraction, LA size or E/e' (averaged) ratio (p&amp;gt;0.05). In patients of the comparison group there were not significant associations of microRNA-133a levels with LV parameters (p&amp;gt;0.05). Conclusion The results of the study indicate a significant role of decreased circulating plasma microRNA-133a levels in patients with arterial hypertension and obesity in the pathogenesis and development of HHD and such its components as LVH and LV DD. Funding Acknowledgement Type of funding source: None

Assessment of Left Ventricular Hypertrophy (LVH) Criteria by Surface Electrocardiography in a Sample of Iraqi Patients with Systemic Arterial Hypertension.

Background:Left ventricular hypertrophy (LVH) in hypertensive patients indicates an ongoing disease process involving the heart. Different electrocardiography (ECG) criteria were investigated; however, the results were conflicting.Objective:To evaluate different ECG criteria in diagnosis of LVH in hypertensive patients using echocardiography as a gold standard.Methods:A hospital based cross sectional observational study which included 140 adult patients with a history of hypertension. Patients were assessed for LVH using five ECG criteria: Romhilt-Estes, SokoloweLyon, Cornell voltage, Gubnere Ungerleider and Peguero-Lo Presti. Echocardiography was used to determine the left ventricular mass index for the patients. The sensitivity and specificity of each ECG criterion was determined considering echocardiography as a gold standard.Results:According to the echocardiographic results, 83 patients (59.29%) were found to have LVH. Age over 40 years, overweight and obesity, high systolic blood pressure (>170 mmHg) and using of antihypertensive drugs were significantly associated with the increased risk of LVH. All included ECG criteria showed low sensitivity and high specificity in detection of LVH in hypertensive patients. There were no significant differences in the efficiency of different ECG criteria in discrimination between mild, moderate and severe cases of LVH.Conclusion:LVH is very common among hypertensive patients, and the sensitivity of ECG criteria is low for these criteria to be clinically used for detection of LVH with high specificity, in which Cornell criterion is the best in detection.

Effect of individualized antihypertensive therapy on the blood pressure and left ventricular hypertrophy of hypertensive patients with coronary heart disease

Objective: To investigate the effect of individualized antihypertensive therapy on the blood pressure and left ventricular hypertrophy (LVH) of hypertensive patients with coronary heart disease (CHD). Methods: We conducted a prospective study from Sep. 2014 to Dec. 2015 in Chinese PLA General Hospital. A total of 650 patients complicated with non-dipper or reverse-dipper hypertension and CHD were enrolled. All the participants were divided into non-dipper (n=259) and reverse-dipper (n=391) group according to their 24h ambulatory blood pressure monitoring (ABPM) reports. Patients who took short-acting antihypertensives changed their medicine to long-acting ones. Patients who had already taken long-acting antihypertensives switched to nighttime or added antihypertensives at night. Self-measured home blood pressure was recorded before going to bed and in the morning. All patients were regularly followed up by face-to-face surveys and clinic BP was recorded every 3 months. After 1 year's follow-up, the effect of individualized antihypertensive treatment on circadian rhythm of blood pressure was evaluated by 24h ABPM. The effect of individualized antihypertensive treatment on LVH was evaluated by echocardiography. Results: After 1 year's individualized antihypertensive therapy, the clinic BP and 24h ABPM of the patients were decreased. BP rhythm in 44% of the non-dipper and 57% of the reverse-dipper patients restored to normal. LVH were returned to normal in 44% of the non-dipper patients and and 48% of the reverse dipper patients, respectively. Left ventricular mass index (LVMI) were (59±12) kg/m(2.7) vs (48±10) kg/m(2.7) (P<0.01), and (63±13) kg/m(2.7) vs (48±11) kg/m(2.7) (P<0.01) respectively in non-dipper and reverse-dipper group before and after individualized antihypertensive treatment. Conclusion: Individualized antihypertensive intervention of abnormal blood pressure circadian rhythm can effectively restore the circadian rhythm of blood pressure and reverse LVH in hypertensive patients with CHD.