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Reversal of hypertensive heart disease

DISCOVERIES (ISSN 2359-7232), 2021, October-December issue

CITATION: 

Ahmed SN, Jhaj R, Sadasivam B, Joshi R. Reversal of hypertensive heart disease: a multiple linear regression model. Discoveries 2021, 9(4): e138. DOI: 10.15190/d.2021.17


Submitted: May 05, 2021; Revised: Nov. 30, 2021; Accepted: Dec. 02, 2021; Published: Dec. 31, 2021.

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Reversal of hypertensive heart disease: a multiple linear regression model

Shah Newaz Ahmed (1,*), Ratinder Jhaj (1), Balakrishnan Sadasivam (1), Rajnish Joshi (2)

(1) Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

(2) Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India


*Corresponding authorsSana Saeed and Qudsia Umaira Khan, CMH Lahore Medical College & Institute of Dentistry, Abdur Rehman Road, Lahore Cantt, Pakistan; Emails: sanasaeed216@gmail.com and drqudsia@yahoo.com respectively.

Abstract

Background: The development of left ventricular hypertrophy in primary hypertension increases cardiovascular mortality and morbidity. Reversal of left ventricular hypertrophy through therapeutic control of blood pressure reduces the risk of adverse cardiovascular incidents.  

Objective:  In our study, we explored for the determinants of left ventricular hypertrophy regression. 

Methods: A cohort (n=217) of patients with hypertensive left ventricular hypertrophy was identified by screening consecutive patients in medical outpatient unit. The primary inclusion criteria were (i) Blood pressure more than140/90 mm of Hg (ii) Left Ventricular Mass Index more than 115 and 95 gm/m2 for males and females respectively. Left Ventricular Mass Index was determined by echocardiography at the time of recruitment and after 24 weeks of standard pharmacotherapy. The change in Left Ventricular Mass Index was modelled using multiple linear regression with both categorical and continuous explanatory variables. The effect of drug therapy on change in Left Ventricular Mass Index was tested in the model with dummy coded variables for the treatment categories. 

Results: In simple linear regression, the variables significantly correlating with change in Left Ventricular Mass Index were baseline Left Ventricular Mass Index (r=0.62, p<0.001), change in systolic blood pressure (r=0.22, p=0.001), change in mean blood pressure (r=0.16, p=0.02), baseline systolic blood pressure (r=0.15, p=0.02), age (r=0.12, p=0.09) and diabetes (r=0.12, p=0.09). The best fit model (r2=0.408) retained baseline Left Ventricular Mass Index (β=0.59, p<0.001), change in systolic blood pressure (β=0.14, p=0.01) and diabetes (β=-0.104, p=0.05) as the significant predictors. Introduction of treatment effect into the model non-significantly increased the fit of the model (r2=0.414, p=0.27-0.98).  

Conclusions: Pre-treatment Left Ventricular Mass Index and reduction in systolic blood pressure were the major determinants of left ventricular hypertrophy regression. We also observed that there is lesser left ventricular hypertrophy regression in diabetic patients, warranting future research to explore glycaemic control as a modifiable factor in left ventricular hypertrophy reversal. 

Access full text of the manuscript here: 

References

1. Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994;90:1786–93 

2. Cuspidi C, Sala C, Negri F, Mancia G, Morganti A; Italian Society of Hypertension. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26:343-9. 

3. Levy D. Echocardiographically Detected Left Ventricular Hypertrophy: Prevalence and Risk Factors: The Framingham Heart Study. Ann. Intern. Med. 1988;108:7. 

4. Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q, et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation 2001;104:1615-21. 

5. Five-year findings of the Hypertension Detection and Follow-up Program. Prevention and reversal of left ventricular hypertrophy with antihypertensive drug therapy. Hypertension Detection and Follow-up Program Cooperative Group. Hypertens. Dallas Tex 1979 1985;7:105-12. 

6. Prineas RJ, Rautaharju PM, Grandits G, Crow R, MRFIT Research Group. Independent risk for cardiovascular disease predicted by modified continuous score electrocardiographic criteria for 6-year incidence and regression of left ventricular hypertrophy among clinically disease free men: 16-year follow-up for the multiple risk factor intervention trial. J. Electrocardiol. 2001;34:91-101. 

7. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004;292:2343-9. 

8. Schmieder RE, Martus P, Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies. JAMA 1996;275:1507-13. 

9. Jennings G, Wong J. Regression of left ventricular hypertrophy in hypertension: changing patterns with successive meta-analyses. J. Hypertens. Suppl. Off. J. Int. Soc. Hypertens. 1998;16:S29-34. 

10. Ahmed SN, Jhaj R, Sadasivam B, Joshi R. Regression of the Left Ventricular Hypertrophy in Patients with Essential Hypertension on Standard Drug Therapy. Discoveries. 2020 Sep 30;8(3):e115. 

11. Ahmed SN, Jhaj R, Sadasivam B, Joshi R. Prediction of Left Ventricular Mass Index Using Electrocardiography in Essential Hypertension - A Multiple Linear Regression Model. Med Devices (Auckl). 2020;13:163-72.

12. Aznaouridis KA, Vyssoulis GP, Karpanou EA, Marinakis AG, Barbetseas JD, Zervoudaki AI, et al. Left ventricular (LV) geometry and dipping state are determinants of LV mass reduction with angiotensin-converting enzyme inhibitor antihypertensive treatment. Blood Press. Monit. 2007;12:87-94. 

13. Sciacqua A, Miceli S, Carullo G, Greco L, Succurro E, Arturi F, et al. One-hour postload plasma glucose levels and left ventricular mass in hypertensive patients. Diabetes Care 2011;34:1406-11.  

14. Seferovic JP, Tesic M, Seferovic PM, Lalic K, Jotic A, Biering-Sørensen T, et al. Increased left ventricular mass index is present in patients with type 2 diabetes without ischemic heart disease. Sci. Rep. 2018;8:926. 

15. Li S, Wang X, Zhao L, Chen M, Long J, Cheng W, et al. The characteristics of 24-hour ambulatory blood pressure monitoring and its relationship with cardiovascular target organ damage in Chinese Han patients with concomitant type 2 diabetes and hypertension. Blood Press. Monit. 2019; 

16. Okin PM, Devereux RB, Gerdts E, Snapinn SM, Harris KE, Jern S, et al. Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy: the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study. Circulation 2006;113:1588-96. 

17. Pouleur A-C, Uno H, Prescott MF, Desai A, Appelbaum E, Lukashevich V, et al. Suppression of aldosterone mediates regression of left ventricular hypertrophy in patients with hypertension. J. Renin-Angiotensin-Aldosterone Syst. JRAAS 2011;12:483-90. 

18. Soliman EZ, Byington RP, Bigger JT, Evans G, Okin PM, Goff DC, et al. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial. Hypertension 2015;66:1123. 

19. Soliman EZ, Ambrosius WT, Cushman WC, Zhang Z, Bates JT, Neyra JA, et al. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Hypertension: The Systolic Blood Pressure Intervention (SPRINT) Trial. Circulation     2017;136:440-50. 

20. Jekell A, Nilsson PM, Kahan T. Treatment of Hypertensive Left Ventricular Hypertrophy. Curr. Pharm. Des. 2018;24:4391-6. 

21. Ahmed SN, Jhaj R., Sadasivam B, Joshi R. The role of renin-angiotensin-aldosterone system inhibition in the regression of hypertensive left ventricular hypertrophy: the evidence of the last three decades. Drugs Ther Perspect 2020;36,509-517 

22. Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT et al. Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens. Dallas Tex 1979 2018;71:e116-35. 

23. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018;39:3021-104.

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