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/m2.7 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/m2.7. 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. © 2017 the authors.