This Article Full Text Full Text (PDF) 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 Ambrosio, G. Search for Related Content PubMed PubMed Citation Articles by Verdecchia, P. Articles by Ambrosio, G. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Cerebrovascular disease/stroke Hypertrophy Electrocardiology Echocardiography Acute Cerebral Hemorrhage Acute Cerebral Infarction Acute Stroke Syndromes Intracerebral Hemorrhage Risk Factors for Stroke Epidemiology

(Circulation. 2001;104:2039.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Left Ventricular Hypertrophy as an Independent Predictor of Acute Cerebrovascular Events in Essential Hypertension

Paolo Verdecchia, MD; Carlo Porcellati, MD; Gianpaolo Reboldi, MD PhD, MSc; Roberto Gattobigio, MD; Claudia Borgioni, MD; Thomas A. Pearson, MD MPH; Giuseppe Ambrosio, MD PhD

From the Dipartimento Malattie Cardiovascolari, Università di Perugia, Ospedale Silvestrini (P.V., C.P., C.B., G.A.), and the Dipartimento di Medicina Interna, University of Perugia (G.R.); Ospedale Beato G. Villa, Città della Pieve (R.G.); and Department of Community and Preventive Medicine (T.A.P.), University of Rochester, Rochester, NY.

Correspondence to Dr Paolo Verdecchia, Dipartimento Malattie Cardiovascolari, Università di Perugia, Ospedale Silvestrini, S Andrea delle Fratte, 06122 Perugia, Italy. E-mail verdec{at}tin.it

Background— It is uncertain whether left ventricular hypertrophy (LVH) confers an increased risk for cerebrovascular disease in apparently healthy patients with essential hypertension.

Methods and Results— A total of 2363 initially untreated hypertensive patients (mean age 51±12 years, 47% women) free of previous cardiovascular disease were followed up for up to 14 years (mean 5 years). At entry, all patients underwent diagnostic tests, including ECG, echocardiography, and 24-hour ambulatory blood pressure (BP) monitoring. At entry, the prevalence of LVH was 17.6% by ECG (Perugia score) and 23.7% by echocardiography (LVM >125 g/m²). Over the subsequent years, 105 patients experienced a first stroke or transient ischemic attack. The cerebrovascular event rate was higher among patients with LVH at entry, diagnosed by either ECG or echocardiography, than among those without hypertrophy (both P<0.01). After control for the significant influence of age, sex, diabetes, and 24-hour mean ambulatory BP, LVH by ECG conferred an increased risk for cerebrovascular events (relative risk [RR] 1.79; 95% CI 1.17 to 2.76). LVH by echocardiography also conferred a higher risk for cerebrovascular events (RR 1.64; 95% CI 1.07 to 2.68). For each increase in LV mass of 1 SD (29 g/m²), there was a significant independent increase in the risk for cerebrovascular events (RR 1.31; 95% CI 1.09 to 1.58).

Conclusions— In apparently healthy patients with essential hypertension, LVH diagnosed by ECG or echocardiography confers an excess risk for stroke and transient ischemic attack independently of BP and other individual risk factors.

Key Words: hypertension • stroke • hypertrophy • prognosis • blood pressure • epidemiology

This article has been cited by other articles:

				A. Scuteri, R. Coluccia, L. Castello, E. Nevola, A. M. Brancati, and M. Volpe Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure Eur. Heart J., June 2, 2009; 30(12): 1525 - 1529. [Abstract] [Full Text] [PDF]

				T. Dieterle, S. Meili-Butz, K. Buhler, C. Morandi, D. John, P. T. Buser, J. Rivier, W. W. Vale, K. L. Peterson, and M. Brink Immediate and Sustained Blood Pressure Lowering by Urocortin 2: A Novel Approach to Antihypertensive Therapy? Hypertension, April 1, 2009; 53(4): 739 - 744. [Abstract] [Full Text] [PDF]

				P. Ruggenenti, I. Iliev, G. M. Costa, A. Parvanova, A. Perna, G. A. Giuliano, N. Motterlini, B. Ene-Iordache, G. Remuzzi, and the BENEDICT Study Group Preventing Left Ventricular Hypertrophy by ACE Inhibition in Hypertensive Patients With Type 2 Diabetes: A prespecified analysis of the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) Diabetes Care, August 1, 2008; 31(8): 1629 - 1634. [Abstract] [Full Text] [PDF]

				A. Mimran and G. du Cailar Dietary sodium: the dark horse amongst cardiovascular and renal risk factors Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2138 - 2141. [Full Text] [PDF]

				C. Strom Moller, J. Haggstrom, B. Zethelius, B. Wiberg, J. Sundstrom, and L. Lind Age and follow-up time affect the prognostic value of the ECG and conventional cardiovascular risk factors for stroke in adult men J Epidemiol Community Health, August 1, 2007; 61(8): 704 - 712. [Abstract] [Full Text] [PDF]

				J. Redon, L. Cea-Calvo, J. V. Lozano, J. C. Marti-Canales, J. L. Llisterri, J. Aznar, J. Gonzalez-Esteban, and on behalf of the investigators of the PREV-ICTUS s Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain: The PREV-ICTUS Study Stroke, April 1, 2007; 38(4): 1167 - 1173. [Abstract] [Full Text] [PDF]

				J. Redon, L. Cea-Calvo, J. V. Lozano, J. C. Marti-Canales, J. L. Llisterri, J. Aznar, J. Gonzalez-Esteban, and on behalf of the investigators of the PREV-ICTUS S Differences in Blood Pressure Control and Stroke Mortality Across Spain: The Prevencion de Riesgo de Ictus (PREV-ICTUS) Study Hypertension, April 1, 2007; 49(4): 799 - 805. [Abstract] [Full Text] [PDF]

				G. Schillaci, M. Pirro, T. Ronti, F. Gemelli, G. Pucci, S. Innocente, C. Porcellati, and E. Mannarino Prognostic Impact of Prolonged Ventricular Repolarization in Hypertension. Arch Intern Med, April 24, 2006; 166(8): 909 - 913. [Abstract] [Full Text] [PDF]

				J. C. Hueb, S. G. Zanati, K. Okoshi, C. N. Raffin, L. V. de Arruda Silveira, and B. B. Matsubara Association Between Atherosclerotic Aortic Plaques and Left Ventricular Hypertrophy in Patients With Cerebrovascular Events Stroke, April 1, 2006; 37(4): 958 - 962. [Abstract] [Full Text] [PDF]

				J. A. Laukkanen, S. Kurl, J. Eranen, M. Huttunen, and J. T. Salonen Left Atrium Size and the Risk of Cardiovascular Death in Middle-aged Men Arch Intern Med, August 8, 2005; 165(15): 1788 - 1793. [Abstract] [Full Text] [PDF]

				N. Glorioso, F. Filigheddu, P. P. Parpaglia, A. Soro, C. Troffa, G. Argiolas, and P. Mulatero 11{beta}-Hydroxysteroid dehydrogenase type 2 activity is associated with left ventricular mass in essential hypertension Eur. Heart J., March 1, 2005; 26(5): 498 - 504. [Abstract] [Full Text] [PDF]

				J. R. Kizer, B. Dahlof, S. E. Kjeldsen, S. Julius, G. Beevers, U. de Faire, F. Fyhrquist, H. Ibsen, K. Kristianson, O. Lederballe-Pedersen, et al. Stroke Reduction in Hypertensive Adults With Cardiac Hypertrophy Randomized to Losartan Versus Atenolol: The Losartan Intervention For Endpoint Reduction in Hypertension Study Hypertension, January 1, 2005; 45(1): 46 - 52. [Abstract] [Full Text] [PDF]

				R. Arya, V. Kedar, J. R. Hwang, H. McDonough, H.-H. Li, J. Taylor, and C. Patterson Muscle ring finger protein-1 inhibits PKC{epsilon} activation and prevents cardiomyocyte hypertrophy J. Cell Biol., December 20, 2004; 167(6): 1147 - 1159. [Abstract] [Full Text] [PDF]

				B. Pitt, N. Reichek, R. Willenbrock, F. Zannad, R. A. Phillips, B. Roniker, J. Kleiman, S. Krause, D. Burns, and G. H. Williams Effects of Eplerenone, Enalapril, and Eplerenone/Enalapril in Patients With Essential Hypertension and Left Ventricular Hypertrophy: The 4E-Left Ventricular Hypertrophy Study Circulation, October 14, 2003; 108(15): 1831 - 1838. [Abstract] [Full Text] [PDF]

				S. L. Seliger, D. L. Gillen, D. Tirschwell, H. Wasse, B. R. Kestenbaum, and C. O. Stehman-Breen Risk Factors for Incident Stroke among Patients with End-Stage Renal Disease J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2623 - 2631. [Abstract] [Full Text] [PDF]

				K. Eguchi, K. Kario, and K. Shimada Greater Impact of Coexistence of Hypertension and Diabetes on Silent Cerebral Infarcts Stroke, October 1, 2003; 34(10): 2471 - 2474. [Abstract] [Full Text] [PDF]

				G. Selvetella, A. Notte, A. Maffei, V. Calistri, V. Scamardella, G. Frati, B. Trimarco, C. Colonnese, and G. Lembo Left Ventricular Hypertrophy Is Associated With Asymptomatic Cerebral Damage in Hypertensive Patients Stroke, July 1, 2003; 34(7): 1766 - 1770. [Abstract] [Full Text] [PDF]

				S. E. Kjeldsen, B. Dahlof, R. B. Devereux, S. Julius, P. Aurup, J. Edelman, G. Beevers, U. de Faire, F. Fyhrquist, H. Ibsen, et al. Effects of Losartan on Cardiovascular Morbidity and Mortality in Patients With Isolated Systolic Hypertension and Left Ventricular Hypertrophy: A Losartan Intervention For Endpoint Reduction (LIFE) Substudy JAMA, September 25, 2002; 288(12): 1491 - 1498. [Abstract] [Full Text] [PDF]