Left ventricular wall stresses and wall stress-mass-heart rate products inhypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study

Objective Left ventricular (LV) hypertrophy on echocardiogram (ECG) strongl y predicts coronary heart disease events, but the mechanisms linking increa sed LV mass to ischemic vascular events is uncertain. Design Variables related to myocardial oxygen demand were compared among no rmotensive adults and patients with mild and more severe hypertension, and among groups of moderately hypertensive patients with target organ damage i n relation to gender, LV geometry and LV systolic function. Setting The Losartan Intervention For Endpoint reduction in hypertension (L IFE) trial, in which hypertensive patients with ECG LV hypertrophy (Cornell voltage-duration product, > 2440 mm x ms and/or SV1 + RV5-6 > 38 mm) were randomized to greater than or equal to 4 years double-blinded treatment wit h losartan or atenolol. Patients/participants A total of 964 LIFE participants enrolled in an echoc ardiographic substudy, and groups of 282 employed hypertensive and 366 appa rently normal adults. Interventions None. Main outcome measures ECG LV parameters contributing to myocardial oxygen d emand (wall stresses, LV mass, heart rate and wall stress-mass-heart rate p roducts). Results In both women and men, stepwise increases from reference subjects t o employed hypertensives to LIFE patients were observed for LV wall stresse s, mass and stress-mass-heart rate products, LIFE men patients had slightly higher wall stresses and significantly higher triple products than women. Wall stresses were increased in patients with normal LV geometry, eccentric or concentric hypertrophy; triple products were about three and two times normal with eccentric and concentric hypertrophy, with smaller increases in other geometric groups. Patients with decreased LV fractional shortening h ad two times normal end-systolic stresses and three or four times normal tr iple products; smaller increases in stresses and triple products occurred w ith decreased LV midwall function. Conclusions Hypertensive patients with ECG LV hypertrophy have increased LV wall stresses and stress-mass-heart rate products, suggesting a contributi on of high myocardial oxygen demand to increased risk in such patients. Par ticularly high stresses and triple products were associated with echocardio graphic LV hypertrophy, and subnormal LV chamber and midwall function, J Hy pertens 2000, 18:1129-1138 (C) Lippincott Williams & Wilkins.