Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network)

Background- Regression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH. Methods and Results- Patients from the Campania Salute Network, free of prevalent cardiovascular disease, but with echocardiographic LVH (defined as LV mass index [LVMi] > 47 g/m(2.7) in women and > 50 g/m2.7 in men) were included. During a median follow-up of 67 months, clear-cut regression of LVH was documented in 14% of patients (13 +/- 8% reduction of initial LVMi) or 23% when also considering those with a reduction of LVMi >= 5 g/m(2.7). Patients with persistent LVH were older with longer duration of hypertension, suboptimal blood pressure (BP) control, larger body mass index, LV mass, and carotid intima-media thickness and included more women and subjects with diabetes mellitus, isolated systolic hypertension, and metabolic syndrome (all P<0.05). Number and class of antihypertensive drugs during follow-up did not differ between groups. In multiple logistic regression analysis, older age, female sex, obesity, higher baseline LVMi and carotid intima-media thickness, and suboptimal BP control were significant covariates of persistent LVH (all P=0.01), independent of diabetes, duration of hypertension, isolated systolic hypertension, follow-up time and number and class of antihypertensive drugs. Conclusions-Early initiation of antihypertensive treatment, aggressive BP control, and attention to metabolic aspects are critical to avoid irreversible LVH.