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Meta analysis suggests regression of left ventricular hypertrophy during antihypertensive treatment is linked to reduced risk of cardiovascular disease
ARTICLE IN PRESS Evidence-based Cardiovascular Medicine (2004) 8, 22–23
Evidence-based
CARDIOVASCULAR MEDICINE www.elsevier.com/locate/ebcm
HYPERTENSION
Meta-analysis suggests regression of left ventricular hypertrophy during antihypertensive treatment is linked to reduced risk of cardiovascular disease$ Abstracted from: Verdecchia P, Angeli F, Borgioni C, et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens 2003;16:895–9. Background Changes in left ventricular mass during treatment for hypertension may predict the risk of subsequent cardiovascular disease. A number of small studies have assessed the effect of serial changes in left ventricular mass on the risk of subsequent cardiovascular events in people with essential hypertension.
Objective This study assessed the prognostic impact of left ventricular hypertrophy regression in essential hypertension. It compared (i) people with left ventricular hypertrophy during treatment (persistence or new development) versus those with left ventricular hypertrophy at baseline, but not during treatment (regression), and (ii) people with left ventricular hypertrophy regression versus those with persistently normal left ventricular mass. The primary endpoint was cardiovascular events.
Method This meta-analysis included four studies. The authors searched Pubmed for studies that reported echocardiographic left ventricular mass before and $
doi of associated commentary: 10.1016/j.ebcm.2003.12.009
doi:10.1016/j.ebcm.2003.12.010
during antihypertensive therapy, assessed subsequent cardiovascular events, were published in a peer reviewed journal up to December 2002, included patients with a clinical diagnosis of essential hypertension and office blood pressure of at least 140 mmHg systolic or 90 mmHg diastolic in more than one visit before treatment, assessed left ventricular wall thickness and diameters using two dimensional guided M mode echocardiography, and calculated left ventricular mass using the cube formula. Experts were contacted for additional studies. The authors used outcome definitions from the primary studies, calculating odds ratios for each cardiovascular outcome. Summary odds ratios were calculated using the Mantel–Haenszel method with fixed effects models.
Participants The meta-analysis comprised 1064 people with essential hypertension and no previous cardiovascular events (41% women). All underwent a repeat echocardiograph 2.8 to 10 years after their initial examination. The mean age at baseline ranged between 45 and 51 years in individual studies. Left ventricular hypertrophy was defined as a left ventricular mass corrected by body surface area greater than 125 g/m2 in two studies and greater than 110 g/m2 for women and 124 g/m2 for men in two studies.
ARTICLE IN PRESS Hypertension
Main results People with left ventricular hypertrophy regression during antihypertensive treatment had a 59% reduced risk of subsequent cardiovascular disease compared to people with no regression or with new development of left ventricular hypertrophy (odds ratio 0.41, 95% CI 0.21 to 0.78, p ¼ 0.007). Results were consistent across individual studies (heterogeneity test p ¼ 0.48). People with persistently normal left ventricular mass had a risk of cardiovascular events similar to those with left ventricular hypertrophy regression (odds ratio 0.64, 95% CI 0.31 to 1.30, p ¼ 0.21). Results were consistent between studies (heterogeneity test p ¼ 0.62).
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risk of subsequent cardiovascular disease. The analysis does not provide conclusive evidence that regression of left ventricular hypertrophy reduces the risk of subsequent events to the same level as people who have never experienced left ventricular hypertrophy.
Overall quality topic importance method quality practical use Poor
Authors’ conclusions The findings suggest that lack of regression or new development of left ventricular hypertrophy is a strong indicator of cardiovascular risk. Reductions in left ventricular hypertrophy during antihypertensive treatment are associated with a reduced
Fair
Good
Excellent
Enquiries to: P Verdecchia, Dipartimento. No details are provided about study sponsorship. Malattie Cardiovascolari, Ospedale R. Silvestrini, Localita‘ S. Andrea delle Fratte, 06156 Perugia, Italy. Email: [email protected] Abstracted by Debbie Singh.
Evidence-based
CARDIOVASCULAR MEDICINE www.elsevier.com/locate/ebcm
HYPERTENSION
Meta-analysis suggests regression of left ventricular hypertrophy during antihypertensive treatment is linked to reduced risk of cardiovascular disease$ Abstracted from: Verdecchia P, Angeli F, Borgioni C, et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens 2003;16:895–9. Background Changes in left ventricular mass during treatment for hypertension may predict the risk of subsequent cardiovascular disease. A number of small studies have assessed the effect of serial changes in left ventricular mass on the risk of subsequent cardiovascular events in people with essential hypertension.
Objective This study assessed the prognostic impact of left ventricular hypertrophy regression in essential hypertension. It compared (i) people with left ventricular hypertrophy during treatment (persistence or new development) versus those with left ventricular hypertrophy at baseline, but not during treatment (regression), and (ii) people with left ventricular hypertrophy regression versus those with persistently normal left ventricular mass. The primary endpoint was cardiovascular events.
Method This meta-analysis included four studies. The authors searched Pubmed for studies that reported echocardiographic left ventricular mass before and $
doi of associated commentary: 10.1016/j.ebcm.2003.12.009
doi:10.1016/j.ebcm.2003.12.010
during antihypertensive therapy, assessed subsequent cardiovascular events, were published in a peer reviewed journal up to December 2002, included patients with a clinical diagnosis of essential hypertension and office blood pressure of at least 140 mmHg systolic or 90 mmHg diastolic in more than one visit before treatment, assessed left ventricular wall thickness and diameters using two dimensional guided M mode echocardiography, and calculated left ventricular mass using the cube formula. Experts were contacted for additional studies. The authors used outcome definitions from the primary studies, calculating odds ratios for each cardiovascular outcome. Summary odds ratios were calculated using the Mantel–Haenszel method with fixed effects models.
Participants The meta-analysis comprised 1064 people with essential hypertension and no previous cardiovascular events (41% women). All underwent a repeat echocardiograph 2.8 to 10 years after their initial examination. The mean age at baseline ranged between 45 and 51 years in individual studies. Left ventricular hypertrophy was defined as a left ventricular mass corrected by body surface area greater than 125 g/m2 in two studies and greater than 110 g/m2 for women and 124 g/m2 for men in two studies.
ARTICLE IN PRESS Hypertension
Main results People with left ventricular hypertrophy regression during antihypertensive treatment had a 59% reduced risk of subsequent cardiovascular disease compared to people with no regression or with new development of left ventricular hypertrophy (odds ratio 0.41, 95% CI 0.21 to 0.78, p ¼ 0.007). Results were consistent across individual studies (heterogeneity test p ¼ 0.48). People with persistently normal left ventricular mass had a risk of cardiovascular events similar to those with left ventricular hypertrophy regression (odds ratio 0.64, 95% CI 0.31 to 1.30, p ¼ 0.21). Results were consistent between studies (heterogeneity test p ¼ 0.62).
23
risk of subsequent cardiovascular disease. The analysis does not provide conclusive evidence that regression of left ventricular hypertrophy reduces the risk of subsequent events to the same level as people who have never experienced left ventricular hypertrophy.
Overall quality topic importance method quality practical use Poor
Authors’ conclusions The findings suggest that lack of regression or new development of left ventricular hypertrophy is a strong indicator of cardiovascular risk. Reductions in left ventricular hypertrophy during antihypertensive treatment are associated with a reduced
Fair
Good
Excellent
Enquiries to: P Verdecchia, Dipartimento. No details are provided about study sponsorship. Malattie Cardiovascolari, Ospedale R. Silvestrini, Localita‘ S. Andrea delle Fratte, 06156 Perugia, Italy. Email: [email protected] Abstracted by Debbie Singh.