[PP.33.06] SUBCLINICAL ORGAN DAMAGE IN HYPERTENSIVE PATIENTS WITH HIGH CARDIOVASCULAR RISK: THE IMPORTANCE OF CHANGES IN LEFT VENTRICULAR MASS - FOLLOW UP

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Abstract

Objective:

The careful assessment of target organ damage is a vital part of the management of any patient with hypertension, particularly for those who are high risk.

Design and method:

We studied 143 hypertensive patients (93 females). Each participant underwent asymptomatic organ damage: 12-lead electrocardiogram examinations, two-dimensional and Doppler echocardiographs, Doppler sonography of the carotid arteries, and laboratory investigations were prospectively followed for total and cardiovascular mortality and disease over a median of 7 years. In this paper, we analyzed the change in LVMI and the relationship with cardiovascular events and malignant diseases.

Results:

In the beginning of the study, the mean age was 63.1 ± 8 years, body mass index of 28.7 ± 3 kg/m2, office blood pressure of 158 ± 16.5 mmHg, left ventricular mass index (LVMI) of 139.2 ± 30.5 g/m2 (63.6% with LVH defined as LVMI> 125 gm2), carotid intimae-medial thickness (IMT) of 0.94 ± 0.2 mm (19.6% was > 0,9 mm) and presence of a plaque in 52.4% patients, medium value estimated GFR 69.3. Diabetes mellitus occurred in 23.1% of patients, impaired fasting glucose occurred in13.3% of patients, and the rate of hypercholesterolemia (defined as cholesterol >5 mmol) was 79.7%.

Results:

A reduction in the LVMI was achieved by 55.9% patients. At the time of follow-up, the incidence of non-fatal and fatal cardiovascular events was significantly greater in patients without a reduction in the left ventricular mass index: 20 (31.7%) vs 11 (13.75%); P < 0.008; higher number of these patients died of cardiovascular causes 5 (7.9%) vs 2 (2.5%), however, the difference was not significant. Between these groups, there was no difference in the incidence of disease 5 (7.9%) vs. 8 (10%) and death (1.6% vs. 1.25%) from cancer.

Results:

There were only two parameters that differed between the groups at the final follow up: mean LVMI (162.7 gm2 vs. 129.9; p < 0.001) and mean systolic blood pressure (148 vs. 141; p < 0.048).

Conclusions:

Our results suggest that a lack of regression of LVH and poor regulation of systolic blood pressure are stronger indicators of cardiovascular risk than subclinical damage to other organs and modifiable risk factors.

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