ATHEROSCLEROSIS AND LEFT-VENTRICULAR HYPERTROPHY - PERSISTING PROBLEMS IN TREATED HYPERTENSIVE PATIENTS

Objectives First, to determine whether hypertensive patients managed i n general practice have more advanced atherosclerosis and left ventric ular hypertrophy than matched normotensive patients from the same prac tices. Second. to investigate the associations of several potentially modifiable factors with these vascular and cardiac outcomes. Design an d methods We performed a case-control study of 500 hypertensive cases (systolic blood pressure greater than or equal to 160 mmHg or diastoli c blood pressure greater than or equal to 95 mmHg or receiving treatme nt) and 506 age- (mean 61 years) and sex- (54% female) matched normote nsive controls recruited from general practices. Carotid artery far wa ll thickness (CWT), assessed by B-mode ultrasound, and left ventricula r mass (LVM), assessed by M-mode echocardiography, were the main study outcome measures. Results Mean systolic/diastolic blood pressure leve ls in the 399 treated cases (145/87 mmHg) were lower than those in unt reated cases (158/94 mmHg) but higher than those in controls (133/82 m mHg, all P< 0.0001), Mean body mass index (BMI) and total triglyceride levels were higher and high-density lipoprotein cholesterol was lower in cases than in controls (all P< 0.0004), Mean CWT was 10% greater i n cases than in controls and LVM was 14% greater (both P< 0.001), but both were similar in treated and untreated cases (P> 0.05), In multiva riate analyses, blood pressure and BMI were both directly and independ ently related to CWT and LVM (both P< 0.0001), Conclusions In this stu dy, hypertensive patients managed in general practice - whether treate d with antihypertensive drugs or not - had more advanced atheroscleros is and left ventricular hypertrophy than did matched normotensive pati ents. Efforts to lower blood pressure further and to reduce BMI could potentially reduce these differences, and this might lead to a reducti on in the risk of major cardiovascular events. J Hypertens 16:1389-139 5 (C) 1998 Lippincott Williams & Wilkins.