Determinants of evolution of ECG signs of left ventricular hypertrophy during long-term antihypertensive treatment in patients with high risk arterial hypertension

Objective: to study the evolution of ECG left ventricular hypertrophy (LVH) in patients with high risk arterial hypertension (AH) with during long-term antihypertensive treatment.
Design and methods. 102 patients (48% males, average age 67,1+0,6) with AH of high risk were randomized to antihypertensive therapy based on AT1 angiotensine II receptors anatagonists (ARA) or dihydropiridine calcium channel blockers (CCB). To achieve target blood pressure (BP) <140/90 mm Hg a diuretic and then other antihypertensive drugs could be added, besides CCB to ARA and ARA or ACE inhibitors to CCB. 12-leads ECG with assessment of ECG criteria of LVH was performed initially and in 1 year. LVH was diagnosed in case of presence of at least one of three criteria (Sokolow-Lyon Index>35 mV, Cornell voltage criteria>20 mV in females and > 28 mV in males and Cornell product >2442 msec*mV).
Results: In 1 year of treatment regress of LVH was observed in 8 from 31 (25,85%) patients with initially ECG- LVH. Patients with regress of ECG - LVH were younger and had lower BMI versus patients with of ECG-LVH persistence (65,5±2,4 vs 66,7±5,9 years and 28,6±5,6 vs 29,2±4,3 kg/m² respectively, n.s.); and significantly lower systolic BP (SBP) after 1 year treatment (137,8±7,6 mmHg vs 142,3±6,2 mmHg respectively). Step logistic regression analysis revealed that SBP was the only independent factor related with regress of ECG-LVH. baseline. Those patients were non significantly older (69,4±6,4 vs 66,0±6,2 years) and had higher blood glucose and total cholesterol levels both at baseline and after 1-year treatment and higher SBP after 1 treatment. Independent correlation with ECG-LVH development was found only for SBP, glucose and total cholesterol vlaues after 1-year treatment. There was no correlation between evolution of LVH and the type of treatmen.
Conclusion. Persistence and development of ECG-LVH in patients with high risk AH during long-term antihypertensive treatment is mainly associated with insufficient SBP control. Data on value of glucose and total cholesterol levels suggests potential benefit of treatment regimens with complex correction of risk factors for prevention of ECG-LVH development.

arterila hypertension, left ventricular hypertrophy, combination antihypertensive therapy

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