REGRESSION OF LEFT VENTRICULAR HYPERTROPHY IN THE HYPERTENSION OPTIMAL TREATMENT STUDY
J. Amerena*, M. Zabalgoitia, Noor U. Rahman, S. Yarows, W. Haley, C. Lucas, C. Yunis, L. Krause, H. Ombao, M. Valentini.
HOT Study Echocardiography Sub-study Investigators.
Objective: To examine the time course and extent of regression of LVH in patients in the Hypertension Optimal Treatment (HOT) study.
Methods: Hypertensive patients (DBP >100 and <115) enrolled in the HOT study in 6 US centres received a feodipine based regiment for a mean of 3.8 years to determine the optimal diastolic blood pressure to maximally decrease cardiovascular events. Serial echocardiography was performed so that changes in LVMI (g/m2) could be related to changes in blood pressure using a linear model for repeated measures.
Results: In the whole group:
|
Baseline |
1 Year |
2 Years |
End |
|
|
SBP/DBP |
167.7/104.9 |
137.7*/81.9* |
136.7/80.5b |
134.4f/80.4 |
|
LVMI |
116.9 (n=596) (n=596) |
118.7(ns) (n=532) |
107.4b (n=359) |
(n=332) |
*p<0.001 base vs 1 yr, bp<0.001 1 yr vs 2 yr, fp<0.001 2 yr vs end
There was no gender effect and significant correlations were found between changes in LVMI and changes in SBP (r=0.135, p=0.015) and DBP (r=0.159 p=0.001) although these were not particularly strong. 42.1% of patients had LVH (LVMI >125g/m2 males, >110g/m2 females ) at baseline and 47% normalised after 2 years of treatment. In 2 years (144.9 +/- 27.1 (n=251) vs 119.6 +/- 28.4 (n=147) p<0.00001) and little further change. In subjects without LVH at baseline there was no decrease in LVMI over 3 years (96.6 +/- 15.9 (n=345) vs 97.5 +/- 20.7 (n=191) p=ns).
Conclusions: treatment of hypertension results in significant regression of LVH, with normalisation of LVMI in some. This improvement occurs over the first 2 years of treatment predominantly in patients with LVH and is not strongly correlated with the magnitude of blood pressure reduction.
