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Circulation, Vol 87, 476-486, Copyright © 1993 by American Heart Association
PR Liebson, G Grandits, R Prineas, S Dianzumba, JM Flack, JA Cutler, R Grimm and J Stamler
BACKGROUND. Echocardiography provides a noninvasive means of assessing left
ventricular (LV) structure and evidence of LV wall remodeling in
hypertensive persons. The relation of demographic, biological, and other
factors with LV structure can be assessed. METHODS AND RESULTS. LV
structure was assessed by M-mode echocardiograms for 511 men and 333 women
with mild hypertension (average blood pressure, 140/91 mm Hg). Measurements
of LV wall thicknesses and internal dimensions were made, and estimates of
LV mass indexes and other derivations of structure were calculated. LV
hypertrophy criteria were based on previously reported echocardiographic
population studies of normal subjects. These measures were compared by age,
sex, race, body mass index, systolic blood pressure, antihypertensive drug
use, physical activity, alcohol intake, cigarette smoking, and urinary
sodium excretion. Despite virtual absence of ECG-determined LV hypertrophy,
13% of men and 20% of women had echocardiographically determined LV
hypertrophy indexed by body surface area (g/m2), and 24% of men and 45% of
women had LV hypertrophy indexed by height (g/m). Black participants had
slightly higher mean levels of wall thickness than nonblack participants
but similar LV mass. Systolic blood pressure and urinary sodium excretion
were significantly and independently associated with LV mass index and LV
hypertrophy using both g/m2 and g/m. Body mass index was significantly
related to LV mass index and LV hypertrophy using g/m. Smoking was
significantly associated with LV mass index, i.e., using continuous
measurement but not using the dichotomy for LV hypertrophy. CONCLUSIONS.
This study of a large population of men and women with mild primary
hypertension, largely without ECG evidence of LV hypertrophy, showed a
substantial percentage of participants with echocardiographically
determined LV hypertrophy. LV mass indexes correlated positively with
systolic blood pressure, body mass index, urinary sodium excretion, and
smoking.
ARTICLES
Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS)
Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago.
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