Abstract 9749: Predictors of Missed Reduction of LV Mass in Unselected Hypertensive Members of the Strong Heart Study

Abstract

Background: Clinical trials indicate that reduction of hypertensive LV mass is a reachable objective during antihypertensive management. Whether similar results can be achieved in usual clinical contexts also in unselected population-based samples is unclear.

Methods: Among 1133 hypertensive participants of the 4^th Strong Heart Study (SHS) exam, 862 (76%, 490 women or 57%) underwent a repeated echocardiogram after 4 yrs (5^th SHS exam) and were analyzed. Variations of at least 5% of the initial values of both systolic blood pressure (SBP) and LV mass index (LVMi) were categorized for analysis.

Results: Compared with the 4^th exam, SBP decreased in 41% of participants, increased in 31% and was unchanged in 28%. LV hypertrophy (LVH) was found in 31% at the 4^th-exam (n=265) and in 37% at the 5^th exam (n=312). LVMi did not change from 4^th to 5^th exam, but in men there was a more significant trend to increase (from 42.0±8.9 to 43.8±9.3 g/m^2.7) than in women (from 45.3±10.5 to 45.8±11.4 g/m^2.7, p<0.004 between genders). Percent (%) change of LVMi was positively related to % change of SBP (r=0.18) and followup SBP (r=0.19, both p<0.0001). Participants who decreased LVMi had initial higher LVMi, HDL-cholesterol and uric acid (UA), with lower heart rate, BMI, waist-to-hip ratio (WHR) and urinary albumin/creatinine ratio (UACR, all 0.05<p<0.0001). Lack of decrese in LVMi was not related to any class of meds used at the time of the 4^th exam (diuretics, ACE-i, ARB, Ca⁺⁺ channel blockers, other vasodilators, β-blockers). In hierarchical logistic regression, adjusting for older age (p<0.02), sex, initial LVMi and field center, lack of decrease in LVMi was independently associated with initially higher BMI (p<0.0001), WHR (p=0.05), UACR (p<0.001), UA (p<0.004) and to the % change of SBP (p<0.005), without additional independent contribution of glucose status (including diabetes), initial SBP and classes of antihypertensive meds.

Conclusions: These results suggest that antihypertensive management does not effectively decrease LV mass in unselected population-based hypertensive subjects. The lack of effect is associated with poor BP control, is predicted by older age, initial central obesity, kidney damage, and is not affected by type of initial antihypertensive therapy.