Initial left-ventricular mass predicts probability of uncontrolled blood pressure in arterial hypertension.

BACKGROUND: Left-ventricular hypertrophy (LVH) is a marker of organ damage in hypertension and helps stratifying cardiovascular risk. Initial left-ventricular mass (LVM) is also a predictor of progression to hypertension, independently of initial blood pressure (BP) and other confounders. OBJECTIVES: To evaluate whether baseline LVM can influence BP control in treated hypertension. METHODS: We evaluated risk of uncontrolled BP (>140 or 90 mmHg under at least two medications), in relation to initial LVM in 4693 hypertensive outpatients (mean age 53±11 years, 43% women, 5% diabetic), without prevalent cardiovascular disease, from the Campania Salute Network. RESULTS: Uncontrolled BP was found in 2240 patients (48%). Participants with initial LVH were more often men, older, diabetic, had higher initial BP, fasting glucose, uric acid and triglycerides, and lower heart rate (HR), high-density lipoprotein-cholesterol and glomerular filtration rate than those without LVH (all P 0.1). Among medication classes, only angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were associated with lower risk of uncontrolled BP (OR=0.83, 95% CI 0.71-0.96; P=0.01), independently of covariates. CONCLUSION: In a population of treated hypertensive patients, initial LVM is a significant predictor of uncontrolled BP, independently of major risk factors and antihypertensive therapy.