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Insuficiencia cardíaca

On-line version ISSN 1852-3862


PISKORZ, Daniel  and  TOMMASI, Alicia. Left ventricular hypertrophy not always reverts with the decrease in blood pressure. Insuf. card. [online]. 2010, vol.5, n.1, pp.11-16. ISSN 1852-3862.

Background. In hypertensive patients it is considered that a fall in blood pressure values is necessary to achieve the regression of target organ damage. The aim of this study is to determine the effect obtained with decreasing blood pressure in hypertensive patients on left ventricular hypertrophy in a specialized clinic. Methods. Hypertensive patients at first consultation as defined by Argentina Cardiology Federation Guides IV, with left ventricular hypertrophy diagnosed by echocardiographic method of Devereux, considering its presence with a left ventricular mass index equal or greater than 110 g/m2 in women and 125 g/m2 in men, divided into two groups: 1) controlled blood pressure: less than 140 - 90 mm Hg or lower than 130 - 80 mm Hg in high risk patients, patients with diabetic nephropathy or ischemic heart disease carriers at end of follow up, 2) uncontrolled blood pressure: above the values set out at the end of follow up. In statistical analysis t students test was applied, considering statistical significance p <0.05, and it was estimated the risk associated with the interval of confidence of 95%. Results. The study included 77 consecutive patients, 41 belonged to group 1 (53.3%) and 36 to group 2 (46.7%), followed for 794 ± 85 days. There were no differences between groups in frequency of sex, mean age, weight, height or body mass index. Patients in group 2 had a higher frequency of type 2 diabetes: 6 patients (16.7%) vs 1 patient (2.4%), p <0.0025. On the first visit patients in group 1 received 0.83 ± 0.92 drugs vs 1.03 ± 0.88 in group 2 (p = NS). At the final visit patients in group 1 were receiving 1.71 ±0.98 drugs vs 1.97 ± 0.85 drugs in group 2 (p = NS). In group 2 received dihydropyridine calcium channel blockers 25% vs 4.9% in group 1 (p <0.0125), no significant differences in the remaining drugs were detected. The initial blood pressure in group 1 was 153 ± 29 / 90 ±15 mm Hg vs 162 ± 27 / 94 ± 13 mm Hg in group 2 (p = NS) and the blood pressure after follow-up was 123 ± 13 / 73 ± 9 mm Hg in group 1 vs 157 ± 14 / 83 ± 11 mm Hg in group 2 (p <0.0005). The initial left ventricular mass index was 144 ± 19 g/m2 in group 1 and 149 ± 29 g/m2 in group 2 (p = NS), while at the end of follow up the left ventricular mass index was 118 ± 37 g/ m2 in group 1 vs 133 ± 45 g/m2 in group 2 (p<0.01). In group 1, 26 patients (63.4%) normalized left ventricular mass index vs 18 patients (50%) in group 2, OR 0.58, confidence interval 95% 0.24 to 1.43. Conclusions. 1) 36.6% of patients normalized blood pressure but did not reach a normal left ventricular mass index in 2 years of follow up, 2) 50% of patients who did not normalize their blood pressure reached a normal left ventricular mass, 3) variables different from blood pressure levels achieved by the treatment may be involved in the regression of target organ damage.

Keywords : Arterial hypertension; Therapeutic goals; Regression; Ventricular hypertrophy.

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