Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension

Background: Hypertrophy and concentric remodeling of the left ventricle are important manifestations of hypertension that are associated with increased morbidity and mortality. Although lifestyle interventions are efficacious in lowering blood pressure, evidence that they have a beneficial effect on target organs has been lacking. Objective: To assess the effects of regular aerobic exercise or exercise plus weight management counseling on left ventricular mass and geometry in overweight, sedentary men and women with high-normal or mildly elevated blood pressure. Methods: Eighty-two participants in a randomized, controlled trial were assigned to supervised aerobic exercise only, a behavioral weight management program that included exercise, or a waiting-list control group for 6 months. Blood pressure and echo cardiographic measures of left ventricular structure were measured at baseline and at the conclusion of the treatment phase. Results: The 45 women and 37 men had a mean +/- SD age of 47 +/- 9 years and had a mean SD blood pressure of 140 +/- 10/93 +/- 5 mm Hg. Blood pressure fell by 7/6 mm Hg in the weight management group and by 3/4 mm Hg in the aerobic exercise group. In association with these decreases in blood pressure, participants in the intervention groups exhibited significant decreases in left ventricular relative wall thickness (P=.003), posterior wall thickness (P=.05), and septal thickness (P=.004) and a trend toward a decrease in indexed left ventricular mass (P=.08) relative to the control group. Conclusions: In a cohort of overweight, sedentary men and women, exercise and weight loss reduced blood pressure and induced favorable changes in left ventricular structure.