This Article Full Text Full Text (PDF) All Versions of this Article: 45/3/412    most recent 01.HYP.0000154822.37141.f6v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Verdecchia, P. Articles by Porcellati, C. Search for Related Content PubMed PubMed Citation Articles by Verdecchia, P. Articles by Porcellati, C. Related Collections Congestive Hypertrophy Clinical Studies Echocardiography Epidemiology

(Hypertension. 2005;45:412.)
© 2005 American Heart Association, Inc.

Original Articles

Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension

Prevalence, Determinants, and Prognostic Value

Paolo Verdecchia; Fabio Angeli; Roberto Gattobigio; Mariagrazia Sardone; Carlo Porcellati

From the Department of Cardiovascular Disease (P.V., F.A., M.S., C.P.), R. Silvestrini Hospital, Perugia; and Division of Medicine (R.G.), Beato G. Villa Hospital, Città della Pieve, Italy.

Correspondence to Paolo Verdecchia, MD, FACC, Dipartimento Malattie Cardiovascolari, Ospedale R. Silvestrini, Località S. Andrea delle Fratte, 06156 Perugia, Italy. E-mail verdec{at}tin.it

Abstract

Prevalence, determinants, and prognostic value of asymptomatic left ventricular systolic dysfunction (LVSD) in uncomplicated subjects with essential hypertension are still incompletely known. We studied 2384 initially untreated subjects with hypertension, no previous cardiovascular disease, and no symptoms or physical signs of congestive heart failure (CHF). These subjects were studied at entry and followed for up to 17 years (mean 6.0). Asymptomatic LVSD (ALVSD), defined by an echocardiographic ejection fraction <50%, was found in 3.6% of subjects. Cigarette smoking (P=0.013), increased left ventricular (LV) mass (P=0.001), and higher 24-hour heart rate (P=0.014) were independent correlates of ALVSD. During follow-up, a first cardiovascular event occurred in 227 subjects, and 24 of these events were hospitalizations for symptomatic CHF. Incidence of CHF per 100 persons per year was 0.12 in patients without and 1.48 in patients with ALVSD (log-rank test P=0.0001). In a Cox model, after adjustment for age (P=0.0001), LV mass (P=0.0001), and cigarette smoking (P=0.039), LVSD conferred a markedly increased risk for CHF (odds ratio, 9.99; 95% confidence interval, 3.67 to 27.2). Incidence of coronary (0.84 versus 0.62x100 person years) and cerebrovascular (0.80 versus 0.62x100 person years) events did not differ (all P=NS) between subjects with and without ALVSD. ALVSD is a potent and early marker of evolution toward severe CHF requiring hospitalization in subjects with essential hypertension.

Key Words: heart failure • ventricular function, left • echocardiography • hypertrophy • blood pressure monitoring, ambulatory

This article has been cited by other articles:

				P. M. Okin, R. B. Devereux, K. E. Harris, S. Jern, S. E. Kjeldsen, S. Julius, J. M. Edelman, B. Dahlof, and for the LIFE Study Investigators Regression of Electrocardiographic Left Ventricular Hypertrophy Is Associated with Less Hospitalization for Heart Failure in Hypertensive Patients Ann Intern Med, September 4, 2007; 147(5): 311 - 319. [Abstract] [Full Text] [PDF]