1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Regression of LV Hypertrophy in Hypertensive Patients

Is LVH regression associated with improved outcomes in hypertensive patients, independent of blood-pressure lowering?

Left-ventricular hypertrophy (LVH) independently predicts cardiovascular (CV) morbidity and mortality, and treating hypertension in patients with LVH reduces CV risk. But is LVH regression associated with improved CV outcomes, independent of blood-pressure lowering?

To find out, researchers analyzed data from the LIFE trial, in which 9193 patients (age range, 55-80) with hypertension and electrocardiographic signs of LVH were randomized to receive the angiotensin-receptor blocker losartan or the beta-blocker atenolol (Journal Watch Cardiology May 17 2002). ECGs were retaken at 6 months and annually thereafter. Mean follow-up was 4.8 years.

After adjustment for randomized treatment, Framingham risk score, baseline and on-treatment BP, and severity of baseline LVH, a decrease of 1 standard deviation in on-treatment LVH was associated with a significantly lower likelihood of experiencing stroke, MI, or CV death (either as a composite endpoint or as separate endpoints). Adjusted hazard ratios associated with 1-SD LVH regression (compared with persistence or progression) ranged from 0.78 to 0.90; all differences were significant. Whether LVH was documented using Cornell product or Sokolow-Lyon voltage criteria did not affect the findings.

In a subset of 941 patients who underwent serial echocardiographic assessments of LV mass index, a 1-SD decrease in that index during treatment was associated with a significantly lower incidence of stroke, MI, or CV death, independent of BP lowering (adjusted hazard ratio, 0.78).

Comment: These data add to our growing understanding of left-ventricular hypertrophy as a CV risk factor and suggest that serial ECG assessments of LVH are useful for monitoring treatment benefit in hypertensive patients with LVH. Although serial echocardiography is more sensitive, recommending it for routine monitoring would be premature. As the editorialists note, to prove definitively that LVH is a reversible cause of poor outcomes, we would need a large-scale randomized trial of a strategy of reducing BP alone versus one of reducing both BP and LVH.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology December 24, 2004

Citation(s):

Okin PM et al. for the LIFE Study Investigators. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004 Nov 17; 292:2343-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Devereux RB et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA 2004 Nov 17; 292:2350-6.

• Original article (Subscription may be required)
• Medline abstract (Free)

Gardin JM and Lauer MS. Left ventricular hypertrophy: The next treatable, silent killer? JAMA 2004 Nov 17; 292:2396-8.

• Original article (Subscription may be required)
• Medline abstract (Free)