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(Hypertension. 2007;49:1077.)
© 2007 American Heart Association, Inc.

Original Articles

Inappropriate Left Ventricular Mass Changes During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

Maria Lorenza Muiesan; Massimo Salvetti; Anna Paini; Cristina Monteduro; Gloria Galbassini; Bianca Bonzi; Paolo Poisa; Eugenia Belotti; Claudia Agabiti Rosei; Damiano Rizzoni; Maurizio Castellano; Enrico Agabiti Rosei

From the Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.

Correspondence to Maria Lorenza Muiesan, Department of Medical and Surgical Sciences, University of Brescia, 25100 Brescia, Italy. E-mail muiesan{at}med.unibs.it

Inappropriate left ventricular mass (LVM; ie, the value of LVM exceeding individual needs to compensate hemodynamic load) predicts the risk of cardiovascular (CV) events, independent of risk factors, either in the presence or in the absence of traditionally defined LV hypertrophy. The relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis was evaluated in 436 prospectively identified uncomplicated hypertensive subjects, with a baseline and follow-up standard clinical evaluation, laboratory examinations, and echocardiogram (last examination: 6±3 years apart), followed for additional 4.5±2.5 years. The appropriateness of LVM to cardiac workload was calculated by the ratio of observed LVM to the value predicted for individual sex, height, and stroke work at rest. At baseline, low or appropriate LVM (128% of predicted) was found in 178 patients, and 258 had inappropriate LVM. A first CV event occurred in 82 patients. Event rate (x100 patient-years) was 3.18 among patients with inappropriate LVM persistence (n=152), 0.97 among patients with inappropriate LVM regression (n=104), 1.87 among patients with inappropriate LVM development (n=75), and 0.81 among patients with persistence of appropriate LVM from baseline to the follow-up (n=105; log-rank test: P=0.0001). Cox’s proportional hazard model, considering all of the known CV risk factors, indicated that age, male sex, persistence, or development of inappropriate LVM, in addition to persistence and development of LVH, were independently associated with the occurrence of CV events (P<0.001). The presence of inappropriate LVM during antihypertensive treatment may adversely influence subsequent CV prognosis.

Key Words: hypertension • hypertrophy left ventricular • echocardiography • prognosis • cardiovascular disease

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