Effect of Treatment of Isolated Systolic Hypertension on Left Ventricular Mass

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Abstract

Context

Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known.

Objective

To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH.

Design

Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP).

Patients

A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms.

Intervention

The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure.

Main Outcome Measure

Change in LV mass assessed by echocardiography.

Results

Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m squared in the active treatment group and 100 g/m squared in the placebo group (P<.001). The LV mass index declined by 13% (95% confidence interval, - 3% to - 23%) in the active treatment group compared with a 6% increase (95% confidence interval, - 3% to + 16%) in the placebo group over 3 years (P=.01).

Conclusion

Treatment of ISH with a diuretic-based regimen reduces LV mass.

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