Izzo R.,Cardiovascular and Immunological science |
De Simone G.,University of Naples Federico II |
De Simone G.,New York Medical College |
Giudice R.,Cardiovascular and Immunological science |
And 5 more authors.
Journal of Hypertension | Year: 2011
Background: Left-ventricular hypertrophy (LVH) is a marker of organ damage in hypertension and helps stratifying cardiovascular risk. Initial left-ventricular mass (LVM) is also a predictor of progression to hypertension, independently of initial blood pressure (BP) and other confounders. Objectives: To evaluate whether baseline LVM can influence BP control in treated hypertension. Methods: We evaluated risk of uncontrolled BP (>140 or 90 mmHg under at least two medications), in relation to initial LVM in 4693 hypertensive outpatients (mean age 53 ± 11years, 43% women, 5% diabetic), without prevalent cardiovascular disease, from the Campania Salute Network. Results: Uncontrolled BP was found in 2240 patients (48%). Participants with initial LVH were more often men, older, diabetic, had higher initial BP, fasting glucose, uric acid and triglycerides, and lower heart rate (HR), high-density lipoprotein-cholesterol and glomerular filtration rate than those without LVH (all P < 0.05). Of 1440 patients with initial LVH, 803 (56%) were uncontrolled at follow-up compared to 44% without LVH (P < 0.0001). In multivariate analyses, odds of uncontrolled BP increased with higher baseline systolic BP [odds ratio (OR) = 1.13 × 5 mmHg, 95% confidence interval (CI) 1.10-1.15], HR (OR = 1.04 × 5 beats/min, 95% CI 1.01-1.07), BMI (OR = 1.03 × kg/m, 95% CI 1.01-1.04), LVM index (OR = 1.05 × 5 g/m, 95% CI 1.01-1.10) and prevalence of diabetes (OR = 5.22, 95% CI 3.52-7.76; all P < 0.05) independently of age, sex, metabolic parameters and number of antihypertensive meds (P > 0.1). Among medication classes, only angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were associated with lower risk of uncontrolled BP (OR = 0.83, 95% CI 0.71-0.96; P = 0.01), independently of covariates. Conclusion: In a population of treated hypertensive patients, initial LVM is a significant predictor of uncontrolled BP, independently of major risk factors and antihypertensive therapy. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.