Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic
AbstractLeft ventricular hypertrophy (LVH) has prognostic significance on cardiovascular mortality and morbidity. However, echocardiography screening for LVH is not routinely done for hypertensive patients in a primary care setting. Thus, this quantitative study aims to determine the prevalence and factors associated with LVH in hypertensive patients at a primary care setting. This was a cross-sectional study of 359 consecutive patients with uncomplicated essential hypertension attending a hospital-based clinic
in Malaysia. All subjects underwent an echocardiography test. LVH occur when the left ventricular posterior wall thickness together with inter-ventricular septal thickness is ≥11 mm. It was found that 24% patients fulfilled the criteria for LVH. The mean age of the study population was 59.2}7.7 years; mean duration of hypertension was 9.7}7.5 years; and mean blood pressure was 136.5/81.5 (}13.7/7.7) mmHg. Using multiple logistic regression analysis, patients who were obese [odds ratio (OR) 8.34, 95% confidence interval (CI) 3.14, 22.22] and male gender (OR 1.96, 95% CI 1.08, 3.16) had significant positive association with LVH. LVH was found in approximately one fourth of the hypertensive patients at a hospital-based primary care setting. There was a significant positive association between LVH and obesity and being male. Guidelines for enhancing use of echocardiography in detecting LVH may be needed.
Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47.
Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease.
Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217-23.
Singh RB, Suh IL, Singh VP, et al. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. J Hum Hypertens.
Institute of Public Health (IPH). The third health and morbidity survey (NHMSIII) 2006, Executive summary: Ministry of Health, Malaysia. 2008.
Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan
Intervention For Endpoint reduction in hypertension study
(LIFE): a randomised trial against atenolol. The Lancet.
European society of Hypertension- European Society of Cardiology Guideline committee. European Society of Hypertension – European society of Cardiology Guideline
for the management of arterial hypertension. J hypertens. 2003;21:1011-153.
Lip GY, Felmeden DC, Li-Saw- Hee FL, et al. Hypertensive heart disease. A complex syndrome or a
hypertensive ‘cardiomyopathy’? Eur Heart J. 2000;21(20):1653-65.
Sundstrom J, Lind L, Arnlov J, et al. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each
other in a population of elderly men. Circulation. 2001;103(19):2346-51.
Levy D, Garrison RJ, Savage DD,et al. Prognostic implications of echocardiographically determined
left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561-6.
Ruilope LM, Schmieder RE. Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens. 2008;21(5):500-8.
Daniel P, Juni P, Egger M, et al. Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic
review. British Medical Journal. 2007;335(7622):711.
Vivencio Barrios, Carlos Escobar, Alberto Calderon, et al. Prevalence of left ventricular hypertrophy detected by Cornell voltageduration product in a hypertensive population. Blood Press. 2008;17(2):110-5.
Jose V Lozano, Josep Redon, Luis Cea-Calvo, et al. Left ventricular hypertrophy in the Spanish hypertensive population. The ERIC-HTA study. Rev Esp Cardiol. 2006;59(2):136-42.
Giuseppe Mancia, Stefano Carugo, Guido Grassi, et al. Prevalence of Left Ventricular Hypertrophy in Hypertensive Patients without and with Blood Pressure Control
De Simone G, Devereux RB, Roman MJ, et al. Relation of obesityand gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension. 1994;23(5):600-6.
Hammond IW, Devereux RB, Alderman MH, et al. Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults. J
Am Coll Cardiol. 1998;12(4):996-1004.
Gosse P, Dubourg O, Gueret P. Regression of left
ventricular hypertrophy with echocardiography: some lessons from the LIVE study. J Hypertens. 2003;21(1):217-21.
Okin P M, Devereux R B, Jern S. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major
cardiovascular events. JAMA. 2004; 292(19):2343-9.
Malmqvist K, Kahan T, Edner M, et al. Regression of left ventricular hypertrophy in human hypertension with Irbesartan. J Hypertens. 2001;19(6):1167-76.
Fagard RH, Celis H, Thijs L, et al. Regression of Left Ventricular Mass by Antihypertensive Treatment. Hypertension. 2009; 54(5):1084-91.
Australian Medical Workforce Advisory Committee. The General Practice Workforce in Australia: Supply and Requirements to 2013 AMWAC Report. 2005; Sydney,
Institute for Health Management, Ministry of Health Malaysia. A study on the adequacy of Outpatient
Management of Essential Hypertension in MOH Hospitals
and Health Centres. 2006.
Sorrentino MJ. Echocardiographic determination of myocardial mass: a review. Am J Physiol Imaging. 1988;3(2):109-13.
Casiglia E, Schiavon L, Tikhonoff V, et al. Electrocardiographic criteria of left ventricular hypertrophy in general population.Eur J Epidemiol. 2008;23(4):261-71.
Okin PM, Devereux RB, Jern S, et al. Regression of Electrocardiographic Left Ventricular Hypertrophy by Losartan Versus Atenolol. Circulation. 2003;108(6):684-90.
Mark J Harry. Basic Echocardiography: An Illustrative
Guide IOWA Heart centre. 1997.
WHO expert consultation. Appropriate body-mass index for Asian populations and implications for policy and intervention strategies. Lancet. 2004;363:157-63.
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint National Committee on Prevention, Detection, Evaluation, and treatment of high Blood
pressure: the JNC7report. JAMA. 2003;289:2560-72.
Fragola PV, De Nardo D, Calo L, et al. Use of the signal-averaged QRS duration for diagnosing left ventricular hypertrophy in hypertensive patients. Int J Cardiol. 1994;44(3):261-70.
Richard S. Crow, Ronald J. Prineas, Pentti Rautaharju, et al. Relation between electrocardiography and echocardiography for left ventricular mass in mild systemic
hypertension The Am J Cardiol. 1995;75(17):1239-43.
Cuspidi C, Sala C, Negri F, et al. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.
Chia Yook Chin, Srinivas Pengal. Cardiovascular Disease Risk in a Semirural Community in Malaysia. Asia Pac J Public Health. 2009;21(4):410-20. [http://aph.sagepub.com/content/21/4/410. short]
Schirmer H, Lunde P, Rasmussen K. Prevalence of left ventricular hypertrophy in a general population; The Tromso Study. Eur Heart J. 1999;20:429-38.
Salvetti G, Pucci A, Fierabracci P, et al. Prevalence of left ventricular hypertrophy and determinants of left ventricular mass in obese women. High Blood Press Cardiovasc Prev. 2012;19(1):33-9.
Michael S Lauer, Keaven M Anderson, William B Kannel, et al. The Impact of Obesity on Left Ventricular Mass and GeometryThe Framingham Heart Study. JAMA.
Chadha DS, Gupta N, Goel K, et al. Impact of obesity on the left ventricular functions and morphology of healthy Asian Indians. Metab Syndr Relat Disord.2009;7(2):151-8.
Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004;110(19):3081-7.
Kathrotia RG, Paralikar SJ, Rao PV, et al. Impact of different grades of body mass index on left ventricular structure and function. Indian J Physiol Pharmacol
Alpert MA. Obesity Cardiomyopathy: Pathophysiology
and Evolution of the Clinical Syndrome. Am J Med Sci.
Lakhani M, Fein S. Effects of obesity and subsequent weight reduction on left ventricular function. Cardiol
Liebson PR, Grandits GA, Dianzumba S, et al. Comparison of Five antihypertensive Monotherapies and Placebo for Change in Left Ventricular Mass in Patients Receiving Nutritional-Hygienic Therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation. 1995;91(3):698-706.