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

Figures & data

Table I. Demographic and clinical characteristics in relation to persistence of mean Cornell product left ventricular hypertrophy during treatment.

Variables	Cornell product ≤ 2440 mm ms (n = 252)	Cornell product > 2440 mm ms (n = 211)	p-value
Age (years)	63.7 ± 6.9	65.7 ± 7.3	0.003
Sex (% female)	40.1	53.1	0.007
Race (% black)	13.5	7.6	0.059
Diabetes (%)	8.7	14.7	0.063
History of IHD (%)	17.5	25.6	0.043
History of MI (%)	6.7	15.6	0.003
History of Stroke (%)	3.2	8.5	0.022
History of PVD (%)	4.4	7.6	0.203
History of HF (%)	2.0	7.1	0.013
Current smoker (%)	23.0	19.9	0.480
Treatment with losartan (%)	54.0	46.9	0.156
Framingham risk score (points)	20.9 ± 9.4	21.5 ± 9.6	0.532
Body mass index (kg/m^2)	27.3 ± 4.6	28.9 ± 6.1	< 0.001
Total cholesterol (mM)	5.75 ± 1.20	5.74 ± 1.26	0.901
HDL-cholesterol (mM)	1.44 ± 0.42	1.39 ± 0.42	0.265
UACR (mg/mM)	3.1 ± 7.0	3.7 ± 7.5	0.368
Glucose (mM)	5.79 ± 2.26	6.01 ± 2.27	0.356
Creatinine (μM)	94.9 ± 24.1	93.6 ± 21.8	0.569

IHD, ischemic heart disease; MI, myocardial infarction; PVD, peripheral vascular disease; HF, heart failure; HDL, high-density lipoprotein; UACR, urine albumin/creatinine ratio.

Table II. Baseline and change from baseline to last in-study measurement of blood pressure and electrocardiographic left ventricular hypertrophy in relation to persistence of mean Cornell product left ventricular hypertrophy during treatment.

Variables	Cornell product ≤ 2440 mm ms (n = 252)	Cornell product > 2440 mm ms (n = 211)	p-value
Baseline measurements
Systolic BP (mmHg)	161 ± 15	162 ± 14	0.527
Diastolic BP (mmHg)	98 ± 8	97 ± 9	0.084
Cornell product (mm ms)	2139 ± 636	3291 ± 937	< 0.001
Sokolow–Lyon voltage (mm)	31.1 ± 10.6	27.4 ± 9.93	< 0.001
Change from baseline to last measurement
Systolic BP (mmHg)	− 36.9 ± 19.2	− 37.8 ± 19.0	0.608
Diastolic BP (mmHg)	− 21.2 ± 9.4	− 20.4 ± 10.5	0.338
Cornell product (mm ms)	− 332 ± 592	− 36 ± 1193	0.001
Sokolow–Lyon voltage (mm)	− 5.3 ± 7.9	− 3.7 ± 6.8	0.029

Figure 1. Kaplan–Meier survival curves illustrating the rate of myocardial infarction according to the presence of left ventricular hypertrophy (LVH) by mean in-treatment Cornell product > 2440 mm ms.

Figure 2. Kaplan–Meier survival curves illustrating the rate of cardiovascular mortality according to the presence of left ventricular hypertrophy (LVH) by mean in-treatment Cornell product > 2440 mm ms.

Figure 3. Kaplan–Meier survival curves illustrating the rate of stroke according to the presence of left ventricular hypertrophy (LVH) by mean in-treatment Cornell product > 2440 mm ms.

Figure 4. Kaplan–Meier survival curves illustrating the rate of the composite endpoint of myocardial infarction, cardiovascular mortality or stroke according to the presence of left ventricular hypertrophy (LVH) by mean in-treatment Cornell product > 2440 mm ms.

Figure 5. Kaplan–Meier survival curves illustrating the rate of all-cause mortality according to the presence of left ventricular hypertrophy (LVH) by mean in-treatment Cornell product > 2440 mm ms.

Table III. Four-year event rates, univariate and multivariable Cox regression analyses to assess the relation of outcomes to persistence of mean Cornell product left ventricular hypertrophy during treatment.

	4-year event rates (%)			Univariate Cox			Multivariate Cox^a
Outcome	CPLVH− (n = 252)	CPLVH+ (n = 211)	p-value	Hazard ratio	95% CI	p-value	Hazard ratio	95% CI	p-value
CV death	3.4	8.9	0.003	3.05	1.41–6.63	0.005	2.51	1.10–5.70	0.028
MI	3.3	7.0	0.010	2.84	1.24–6.54	0.014	1.81	0.71–4.58	0.214
Stroke	2.1	8.5	0.002	3.81	1.51–9.59	0.005	2.63	1.03–6.97	0.047
Composite endpoint	7.0	20.0	< 0.001	3.26	1.89–5.64	< 0.001	2.46	1.36–4.45	0.003
All-cause mortality	10.0	14.9	0.015	1.71	1.07–2.74	0.026	1.46	0.87–2.45	0.154

^aAdjusted for the randomized treatment allocation, Framingham risk score and the propensity score for persistent mean in-treatment Cornell product left ventricular hypertrophy entered as standard covariates and baseline and in-treatment diastolic blood pressure and Sokolow–Lyon voltage entered as time-varying covariates. CPLVH, mean Cornell product left ventricular hypertrophy; CV, cardiovascular; MI, myocardial infarction.

Table IV. Univariate Cox analyses to assess the predictive value of persistence of mean Cornell product left ventricular hypertrophy during treatment for the composite endpoint in relevant subgroups of the study population.

Subgroup	Composite endpoint (n)	χ^2	p-value	Hazard ratio	95% CI	p-value for interaction
Treatment						0.244
Atenolol (n = 228)	35	10.92	0.001	3.78	1.72–8.33
Losartan (n = 235)	28	6.47	0.011	2.73	1.26–5.92
Sex						0.287
Male (n = 250)	40	19.35	< 0.001	4.47	2.37–9.52
Female (n = 213)	23	2.71	0.100	2.11	0.87–5.13
Age (years)						0.054
Less than 65 (n = 256)	18	10.82	0.001	8.01	2.32–27.66
65 or greater (n = 207)	45	4.42	0.036	1.94	1.05–3.61
Sokolow–Lyon voltage LVH on baseline ECG						0.263
No (n = 367)	49	15.35	< 0.001	3.83	1.96–7.49
Yes (n = 96)	14	2.72	0.061	2.72	0.95–7.76

LVH, left ventricular hypertrophy; ECG, electrocardiogram.