Abstract 14284: Clinical Predictors of Development of New Lv Hypertrophy in Treated Hypertensive Patients

Abstract

Background: LV hypertrophy (LVH) is a marker of target organ damage in hypertension and the strongest predictor of major cardiovascular (CV) events. LV mass (LVM) frequently increases in subjects during antihypertensive management. This study was designed to evaluate incidence of LVH in a large cohort of treated hypertensive patients, and identify the clinical phenotype at risk of development of LVH.

Methods: We retrospectively evaluated 2726 treated hypertensive patients (50±11 yrs, 40 % women, 142±15 mmHg systolic, 90±10 mmHg diastolic blood pressure [BP] at the first available visit), without prevalent CV disease or LVH, glomerular filtration rate (GFR)> 30 mL/min/1.73 m², and with a follow-up ≥12 months. LVH was detected at the last visit as LVM index (LVMi)≥ di 49.2 g/m^2.7 in men and ≥46.7 g/m^2.7 in women.

Results: After a mean follow-up of 69±45 months, 17% of the population (457 patients) had new LVH. Patients with incident LVH were older, more often diabetic, with longer follow-up time and duration of hypertension, higher baseline BMI, and higher values of baseline and final systolic BP (all p<0.0001). At baseline, patients with incident LVH also exhibited greater carotid intima-media thickness (IMT) and LV mass index (both p<0.001) and were prescribed more antihypertensive meds during follow-up than those maintaining normal LVMi. In particular they were taking more frequently diuretics and calcium channel blockers (both p <0.001). In a model of multiple logistic regression, including all variables that differed in descriptive statistics, new LVH was confirmed to be independently predicted by older age (p=0.0001; OR= 1.03/year; CI= 1.01-1.05), higher baseline LV mass index (p<0.0001; HR=1.26; CI=1.21-1.32), BMI (p<0.0001; HR = 1.09/kg*m^-2; CI = 1.05[[Unable to Display Character: &#8211;]]1.14), final values of systolic BP (p<0.0001; HR=1.02/mmHg; CI=1.01-1.04), and greater number of antihypertensive meds during follow-up (p<0.02; HR=1.24; CI=1.03-1.46), without specific effect of classes of meds.

Conclusions: In a retrospective analysis, clinical predictors of development of LVH in a population of treated hypertensive patients were older age, higher baseline values of LVM and BMI, less controlled systolic BP and greater number of antihypertensive meds during follow-up.