Left ventricular mass and function in primary hypertension.

Abstract

The Hypertension Optimal Treatment study is a prospective, randomized, clinical trial designed to challenge the J curve phenomenon in hypertension. A subpopulation of 665 patients from seven participating centers in the United States were enrolled to evaluate the prevalence of left ventricular mass and its relationship to systolic and diastolic function, as assessed by Doppler echocardiography, and to clinical events during the length of the study. Echocardiographic measurements followed stringent criteria and were rechecked in a core laboratory for accuracy. Baseline data revealed left ventricular hypertrophy in 62% of the patients. Left ventricular hypertrophy was more prevalent in women than in men (72% v 57%, P < .0001). The hypertrophy was further characterized according to left ventricular geometry and found the concentric pattern as the predominant form of hypertrophy (46%). Indices of left ventricular systolic function, including fractional shortening, cardiac index, and ejection fraction, were normal or above-normal. Doppler interrogation of the mitral inflow demonstrated left ventricular diastolic dysfunction in 81% of patients. The constrictive physiology (inversion of the E/A ratio) was the most prevalent mitral flow pattern (79%). Regression of left ventricular hypertrophy, modification of mass index geometry, and alterations in mitral flow characteristics under optimal blood pressure control will be specifically compared with subsequent examinations.