Prognostic value of left ventricular mass and its evolution during treatment in the Bordeaux cohort of hypertensive patients

Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular complications independently of other known risk factors, but so far the predictive value of its evolution under treatment has been stud ied relatively little. Since 1983 we have followed up a cohort of initially untreated hypertensive patients with echocardiographic measurements of lef t ventricular mass (LVM). We analyzed the data on 474 patients with more th an 5 years of follow-up to assess the prognostic value of LVM and its evolu tion during treatment for high blood pressure. A total of 40 patients were lost to follow-up. The mean follow-up period was 89 +/- 31 months. A cardio vascular complication was recorded in 40 individuals. There was a strong li nk between increased LVM and the occurrence of complications (P < .001). At least a second determination of LVM was performed in 311 patients, and the last value before the occurrence of any complication (60 +/- 38 months aft er the initial examination) was retained. In this subgroup, 28 patients pre sented with a cardiovascular event. There was a trend toward a reduction of the incidence of events in the group with a regression of LVH as compared to the group with persistent LVH, but there was no difference when patients were split into quartiles according to LVM evolution between baseline and followup. Thus, the reduction of LVM on treatment was not a good marker of future cardiovascular events and its seems at least premature to say that L VM fulfils all conditions for a surrogate end point in the evaluation of mo rbidity/mortality in the hypertensive. (C) 2001 American Journal of Hyperte nsion, Ltd.