Persistence of left ventricular hypertrophy is associated with increased cardiovascular morbidity and mortality in hypertensive patients with lower achieved systolic pressure during antihypertensive treatment

Abstract

Aim. To determine if persistence of electrocardiographic (ECG) left ventricular hypertrophy (LVH) during aggressive systolic blood pressure (SBP) lowering would identify patients at increased risk. Methods and results. Adjudicated outcomes were examined in relation to the presence of LVH by mean in-treatment Cornell product (CP) in 463 hypertensive patients with mean in-treatment SBP ≤ 130 mmHg randomly assigned to losartan- or atenolol-based treatment. During mean follow-up of 4.4 ± 1.3 years, persistence of mean CP > 2440 mm ms in 211 patients (45.6%) was associated with significantly higher 4-year rates of cardiovascular death (8.9% vs 3.4%, p = 0.003), myocardial infarction (7.0% vs 3.3%, p = 0.010), stroke (8.5% vs 2.1%, p = 0.002), the composite endpoint of these events (20.0% vs 7.0%, p < 0.001) and all-cause mortality (14.9% vs 10.0%, p = 0.015). In multivariate Cox analyses, adjusting for a propensity score for CP LVH, randomized treatment and Framingham risk score entered as standard covariates and in-treatment diastolic BP and Sokolow–Lyon voltage LVH entered as time-varying covariates, persistence of CP LVH remained associated with statistically significant increased risks of cardiovascular death (hazard ratio, HR = 2.51, 95% CI 1.10–5.70), stroke (HR = 2.63, 95% CI 1.03–6.97) and the composite endpoint (HR = 2.46, 95% CI 1.36–4.45). Conclusions. These findings suggest that persistence of LVH in a subset of these patients may in part explain the lack of benefit found in hypertensive patients despite treatment to lower SBP.

Key Words::

• Electrocardiogram
• hypertension
• hypertrophy

Funding sources

Supported in part by grant COZ-368 and an Investigator Initiated Study grant from Merck & Co., Inc., West Point, PA, USA.

Disclosures

Dr. Okin has received grant support from Merck & Co., Inc. and Novartis, serves on a medical advisory board for GE Medical Systems and as a consultant to Novartis. Ms. Hille is employed by Merck & Co., Inc. and owns stock or stock options in Merck & Co., Inc. Dr. Kjeldsen receives grant support from Pronova and Astra-Zeneca, receives honoraria from Astra-Zeneca, Takeda, Medtronic and Nycomed, serves as a consultant to Bayer, Medtronic, Serodeus and Takeda, and receives royalties from Gyldendal. Dr. Dahlöf has received honoraria, support for travel to meetings, fees for participating in monitoring boards and administrative support from MSD, served on boards for Novartis and Boehringer-Ingelheim, been a consultant for Boryung, served on speakers bureaus for Novartis, Boehringer-Ingelheim, Pfizer, MSD, Krka, Vicore Pharma and Lundbeck and owns stock or stock options in Mintage Scientific AB. Dr. Devereux has received grant support, consulting fees and support for travel to meetings from Merck & Co., Inc.

Clinical Trials Registration: http://clinicaltrials.gov/ct/show/NCT00338260?order = 1

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.