THE IMPACT OF LEFT VENTRICULAR HYPERTROPHY ON OPTIMAL BLOOD PRESSURE CONTROL

Objective: We aimed to investigate the determinant factors of blood pressure (BP) control achievement and in particular the impact of left ventricular hypertrophy (LVH) regression, determined by echocardiography, in hypertensive patients during a follow up period under treatment. Design and method: 2380 hypertensive subjects, (mean age 58 ± 12 years), 50.3% males, with baseline office BP 143/89 mmHg were followed for a mean period of 5.3 ± 3.3 years. At baseline and last follow-up visit all patients underwent office BP and laboratory evaluation and echocardiographical determination of left ventricular mass index (LVMI). Main outcome variable was BP control, which was considered optimal when the mean of office BP measurements during follow-up was <140/90 mmHg.LVH Regression/prevention (LVH Regr/prev) was defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. Results: During follow-up period, 44.7% of study population presented LVH Regr/prev and56.9% achieved optimal BP control. Cox-regression analysis, after adjustment for confounding factors (metabolic, clinical and treatment parameters) revealed that LVH Regr/prev (HR = 1.20, 95% CI 1.01–1.43, p < 0.01), low baseline BMI levels (HR = 0.97, 95% CI 0.95–0.99, p < 0.01) and hypertension duration (HR = 0.98, 95% CI 0.97–0.99, p = 0.004) were independent predictors of optimal BP control during follow-up. Conclusions: The present study demonstrated that LVH regression was an independent predictor of BP control during a long follow up period. LVH regression or prevention of new-onset LVH may reliably predict the efficacy of antihypertensive therapy and thus help the improvement of cardiovascular risk stratification and the management of hypertension.