IMPACT OF LEFT-VENTRICULAR STRUCTURE ON THE INCIDENCE OF HYPERTENSION- THE FRAMINGHAM HEART-STUDY

Background Left ventricular hypertrophy is often found very early in t he course of hypertension. It is not known whether increased left vent ricular mass contributes to the pathogenesis of hypertension. The purp ose of this study was to examine the impact of left ventricular mass a nd other echocardiographically assessed cardiac structural features on the incidence of hypertension. Methods and Results Subjects for this investigation included participants in the Framingham Heart Study and the Framingham Offspring Study who were normotensive at the baseline e xamination (systolic blood pressure, <140 mm Hg; diastolic blood press ure, <90 mm Hg; not receiving antihypertensive medications) and free o f coronary heart disease, congestive heart failure, valvular heart dis ease, hypertrophic cardiomyopathy, diabetes mellitus, and renal insuff iciency. The study sample included 1121 men (mean age, 44.4 years) and 1559 women (mean age, 45.6 years). Four years after the baseline exam ination, 202 men (18.0%) and 257 women (16.5%) were hypertensive (syst olic blood pressure, greater than or equal to 140 mm Hg; diastolic blo od pressure, greater than or equal to 90 mm Hg; or use of antihyperten sive medications). Baseline echocardiographic left ventricular mass (P =.01) and the sum of septal and posterior left ventricular wail thickn esses (P=.02) were associated with progression to hypertension. After adjusting for sex, baseline age, systolic and diastolic blood pressure s, body mass index, alcohol intake, and systolic blood pressure from a n examination 8 years earlier, the odds ratio for developing hypertens ion for a 1-SD increment in left ventricular mass index was 1.20 (95% confidence interval, 1.04 to 1.39), and the odds ratio for a 1-SD incr ement in left ventricular wall thickness was 1.16 (95% confidence inte rval, 1.02 to 1.33). Conclusions In these normotensive adults, increas ed left ventricular mass and wall thickness were associated with the d evelopment of hypertension. Further studies are warranted to examine t he utility of echocardiography in determining the need for antihyperte nsive therapy and to assess the effect of earlier intervention an the course of progression to hypertension.