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Regression of left ventricular hypertrophy and microalbuminuria changes during antihypertensive treatment.

Abstract：

OBJECTIVE:The objective of the present study was to assess the regression of left ventricular hypertrophy (LVH) during antihypertensive treatment, and its relationship with the changes in microalbuminuria. INDIVIDUALS AND METHODS:One hundred and sixty-eight previously untreated patients with echocardiographic LVH, 46 (27%) with microalbuminuria, were followed during a median period of 13 months (range 6-23 months) and treated with lifestyle changes and antihypertensive drugs. Twenty-four-hour ambulatory blood pressure monitoring, echocardiography and urinary albumin excretion were assessed at the beginning and at the end of the study period. RESULTS:Left ventricular mass index (LVMI) was reduced from 137 [interquartile interval (IQI), 129-154] to 121 (IQI, 104-137) g/m (P < 0.001). Eighty-nine patients (53%) had a reduction in LVMI of at least 17.8 g/m, and an LVH regression rate of 43.8 per 100 patient-years [95% confidence interval (CI) 35.2-53.9]. The main factor related to LVH regression was the reduction in SBP24 h [multivariate odds ratio (ORm) 4.49; 95% CI 1.73-11.63; P = 0.005, highest tertile compared with lower tertiles]. Male sex (ORm 0.39; 95% CI 0.17-0.90; P = 0.04) and baseline glomerular filtration rate less than 90 ml/min per 1.73 m (ORm 0.39; 95% CI 0.17-0.90; P = 0.03) were associated with a lower probability of LVH regression. Patients with microalbuminuria regression (urinary albumin excretion reduction >50%) had the same odds of achieving regression of LVH as patients with normoalbuminuria (ORm 1.1; 95% CI 0.38-3.25; P = 0.85). However, those with microalbuminuria at baseline, who did not regress, had less probability of achieving LVH regression than the normoalbuminuric patients (OR 0.26; 95% CI 0.07-0.90; P = 0.03) even when adjusted for age, sex, initial LVMI, GFR, blood pressure and angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) treatment during the follow-up. CONCLUSION:Patients who do not have a significant reduction in microalbuminuria have less chance of achieving LVH regression, independent of blood pressure reduction.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Rodilla E,Pascual JM,Costa JA,Martin J,Gonzalez C,Redon J

doi

10.1097/HJH.0b013e328361461e

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

1683-91

issue

eissn

0263-6352

issn

1473-5598

pii

00004872-201308000-00027

journal_volume

pub_type

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Regression of left ventricular hypertrophy and microalbuminuria changes during antihypertensive treatment.