Clinical Question: Should antihyper...

Clinical Question: Should antihypertensive therapy be targeted at regression or prevention of left ventricular hypertrophy (LVH)?

Setting: Outpatient (any)

inquiry Design: Cohort (retrospective)

Synopsis: In this consideration investigators wished to assess the possible association between reduction of LVH as determined by dint of electro-cardiography (ECG) during antihypertensive treatment and a reduction in rates of morbidity and/or mortality. They examined data from the previously published Losartan Intervention For Endpoint (LIFE) reduction in hypertension research which randomized patients with hypertension and ECG-deter-mined LVH to treatment with losartan or atenolol. Follow-up assessments, including at least common annual ECG, continued for four years or more.

After controlling for treatment collection assignment, baseline cardiovascular risk scores, baseline and in-treatment offspring pres-sure, and severity of baseline ECG-determined LVH through time the less severe in-treatment ECG-determined LVH was associated with a significantly reduc risk of adverse cardio-vascular results including a reduced risk of cardiovascular death, myocardial infarction, or death.

Another contemplation evaluating LVH that was determined by dint of echocardiogram reported similarly that lower left ventricular mass during antihypertensive treatment was associated with a reduc risk of adverse results (Devereux RB, et al. Prognostic significance of left ventricular mass change during treatment of hypertension.

JAMA 2004;292:2350-6) The authors of the two papers suggested that anti-hypertensive therapy should be targeted at regression or prevention of ECG- or echocardiogram-determined LVH

This means of study design, however, was inadequate to make a firm recommendation forward the value of measuring LVH regression, and may instead simply measure the value of patient compliance. In other words, patients from the two treatment groups who were greatest in quantity compliant with their antihy-pertensive medication regimens were more likely to point out to a reduction in LVH than those who were not. Likewise, those same patients were more likely to tread in the steps of other physician advice about smoking, diet, exercise, and likewise forth, and, therefore, would be more likely to have a reduc risk of adverse cardiovascular events

As noted in an editorial in this same issue, the and nothing else study design that was clearly able to bring to an end that antihypertensive therapy should be directed from the effect of treatment forward a reduction of LVH, instead of by way of meeting target blood pressure goals, is a direct comparison of issues of patients randomly assigned to single in kind treatment group or the other.

Bottom Line: During antihypertensive therapy, les rigid LVH is associated with a reduc risk of cardiovascular morbidity and mortality. This risk reduction is independent of vital current pressure treatment modality and actual posterity pressure reduction. The cur-rent consideration design is inadequate for evaluating treatment guided by means of LVH reduction compared with the popular method of goal-directed blood squeezing lowering. Further studies are straited before clinical practice should be changed. (Level of Evidence: 2b)

studious mood Reference: Okin PM, et al. Regression of electro-cardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardio-vascular affairs JAMA November 17, 2004;292:2343-9.

Used with permission from Slawson D Regression of LVH with hypertension predicts reduc CVD risk. Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

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