Abstract 3782: Persistent Prehypertension is a Risk Factor for Left Ventricular Hypertrophy
BACKGROUND: We aimed to study whether persistent prehypertension has detrimental effects on left ventricular (LV) geometry and function and increases cardiovascular risk.
METHODS: Subjects (n=1005, aged 25 to 74 years) from a gender and age stratified random sample of residents of the Augsburg (D) area, were examined by standardized echocardiography at baseline and a second time, at a ten year follow-up. We defined two groups of individuals who persistently had either normal systolic and diastolic blood pressures (nBP, i.e., <120 mm Hg and <80 mm Hg; n=142) or prehypertensive blood pressures (preBP, 120 – 139 mm Hg or 80 – 89 mm Hg; n=119) at both examinations. We prospectively evaluated temporal changes in geometry, mass and function occurring with either persistent normotension or prehypertension using linear regression models adjusting for relevant confounders. Subjects taking antihypertensive medications or having hypertensive blood pressures (≥ 140 mm Hg or ≥ 90 mm Hg) were excluded from this analysis.
RESULTS: After ten years of follow-up, individuals with preBP , as compared to nBP, showed larger relative increases in LV wall thickness (WT, 11.9% [95% CI: 9.3 to 14.5] versus 4.7% [2.4 to 7.1]; p<0.001), relative wall thickness (RWT, 12.9% [9.3 to 16.5] versus 4.3% [1 to 7.5]; p=0.001) and LVM indexed to height2.7 (LVM/height2.7, 15.8% [12.4 to 19.3] versus 8.5% [5.4 to 11.6]; p=0.004) and decrease in E/A (early/late diastolic peak transmitral flow velocity, 15.7% [12 to 19.3] versus 7.7% [4.4 to 11]; p=0.003), respectively. Persistent prehypertension was also associated with a markedly elevated incidence of concentric remodeling of the left ventricle (RWT >0.43) with an odds ratio OR =9.38 [2.94 to 29.9] (p<0.001), of LV hypertrophy (LVM/height2.7 >44 g/m2.7 in women and >48 g/m2.7in men) with OR =5.59 [1.69 to 18.4] (p=0.009) and of diastolic dysfunction (E/A <1 or E/A ≥ 1 and left atrial end-systolic diameter larger than 40 mm for males or 38 mm for females) with OR=2.52 [1.01 to 6.31] (p=0.048).
CONCLUSIONS: Persistent prehypertension is associated with an increased risk of concentric remodelling and hypertrophy of the left ventricle and a worse diastolic function suggesting that prehypertension is related to detrimental alterations of the left ventricle.