Inappropriate left ventricular mass changes during treatment adversely affects cardiovascular prognosis in hypertensive patients

Inappropriate left ventricular mass (LVM; ie, the value of LVM exceeding individual needs to compensate hemodynamic load) predicts the risk of cardiovascular ( CV) events, independent of risk factors, either in the presence or in the absence of traditionally defined LV hypertrophy. The relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis was evaluated in 436 prospectively identified uncomplicated hypertensive subjects, with a baseline and follow-up standard clinical evaluation, laboratory examinations, and echocardiogram ( last examination: 6 +/- 3 years apart), followed for additional 4.5 +/- 2.5 years. The appropriateness of LVM to cardiac workload was calculated by the ratio of observed LVM to the value predicted for individual sex, height, and stroke work at rest. At baseline, low or appropriate LVM ( <= 128% of predicted) was found in 178 patients, and 258 had inappropriate LVM. A first CV event occurred in 82 patients. Event rate ( x 100 patient-years) was 3.18 among patients with inappropriate LVM persistence ( n = 152), 0.97 among patients with inappropriate LVM regression ( n = 104), 1.87 among patients with inappropriate LVM development ( n = 75), and 0.81 among patients with persistence of appropriate LVM from baseline to the follow-up ( n = 105; log-rank test: P = 0.0001). Cox's proportional hazard model, considering all of the known CV risk factors, indicated that age, male sex, persistence, or development of inappropriate LVM, in addition to persistence and development of LVH, were independently associated with the occurrence of CV events ( P < 0.001). The presence of inappropriate LVM during antihypertensive treatment may adversely influence subsequent CV prognosis.