A major cause of left ventricular hypertrophy (LVH) is an excessive hemodynamic load, making LVH more common among people with hypertension. Clinical trials of antihypertensive medication have found that treatment reduces left ventricular mass among those with hypertension, but little is known about the prevalence of LVH in the general population that are taking, and not taking, antihypertensive medication. We examined the cross-sectional association between blood pressure control and LVH among 28,106 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, to test the hypotheses that: 1) within strata of blood pressure control, LVH will be more prevalent in those requiring more intensive treatment, and 2) that within strata of intensiveness of blood pressure treatment, that LVH will be more prevalent at higher blood pressure levels.
The REGARDS study enrolled black and white participants, aged 45 and older, from 2003-2007. Systolic blood pressure was defined as normal (<120 mmHg), prehypertension (120 mmHg - 139 mmHg), stage 1 (140 mmHg - 159 mmHg), and stage 2 hypertension (>160 mmHg). Classes of antihypertensive medications at baseline were defined as 0, 1, 2, or 3 or more. LVH by electrocardiogram was detected in 2,803 participants. Multivariable-adjusted odds ratios (ORs) for LVH and 95% confidence intervals (CIs) were calculated using logistic regression models.
The ORs (95% CIs) for each additional medication class were 1.31 (1.20-1.43) for normal blood pressure, 1.21 (1.14-1.27) for prehypertension, 1.07 (0.98-1.16) for stage 1, and 1.02 (0.88-1.17) for stage 2. The ORs (95% CIs) for each additional increase in blood pressure category were 1.57 (1.41-1.75) for no medications, 1.47 (1.33-1.63) for 1, 1.30 (1.18-1.43) for 2, and 1.21 (1.10-1.34) for 3 medications.
We observed that successful blood pressure control by medication is still associated with elevated odds of LVH compared to untreated normotensive participants, emphasizing the importance of hypertension prevention.
THE IMPACT OF LEFT VENTRICULAR HYPERTROPHY ON OPTIMAL BLOOD PRESSURE CONTROL
