Left ventricular hypertrophy strongly predicts cardiovascular risk and calls for aggressive therapeutic management of all reversible risk factors, according to an article in the November issue of the American Journal of Hypertension.

The Italian research team conducted a meta-analysis of 4 studies involving 1,064 patients (627 men, 437 women) with hypertension who were 45 to 51 years old at baseline. Each participant received a baseline (pretreatment) echocardiographic study and a follow-up study (follow-up durations 2.8 years to 10 years).

Among the 4 studies, the prevalence of left ventricular hypertrophy at baseline ranged from 22 to 44 percent. At follow-up, most patients were receiving multidrug therapy for hypertension. Between baseline and follow-up study, there were a total of 29 cases of stroke, 22 cases of myocardial infarction, 29 cases of a composite endpoint (new onset angina or a revascularization procedure), 9 cases of congestive heart failure, and 18 cases of a second composite endpoint (transient ischemic attack, sudden cardiac death, dialysis, or evidence of peripheral occlusive disease).

Overall, regression in left ventricular hypertrophy between baseline and follow-up studies was associated with a dramatic 59 percent reduction in risk of adverse events. The authors commented, "Regression of left ventricular hypertrophy may influence the risk of coronary events through an improved coronary flow, lesser arrhythmias, and a better systolic and diastolic performance."

The authors also noted the importance of new onset hypertrophy in patients being treated for hypertension: "Lack of regression or new development of left ventricular hypertrophy over time should be considered as a strong indicator of risk. An aggressive therapeutic management of all reversible risk factors is advisable in these patients. Furthermore, our study supports the suggestion that changes in left ventricular mass may be reliable surrogate end-points in intervention trials."

"This study confirms the importance of echocardiography to help physicians identify those patients with high blood pressure who are in danger of adverse cardiovascular events," said Michael A. Weber, MD, an editor of the Journal. "Early identification can help initiate appropriate therapy to reduce the risk of heart attacks."