Lack of regression of left ventricular hypertrophy is associated with higher incidence of revascularization in hypertension: The LIFE Study.

摘要

OBJECTIVE: Regression of left ventricular (LV) hypertrophy and albuminuria in hypertension has previously been shown to reduce clinical cardiovascular events and death. We aimed to investigate the associations of regression of electrocardiographic (ECG) LV hypertrophy and albuminuria with the incidence of revascularization. METHODS: In 9193 hypertensive patients included in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, we measured urine albumin/creatinine ratio (UACR), LV hypertrophy by electrocardiography, serum high-density lipoprotein (HDL) cholesterol, and blood pressure after 2 weeks of placebo treatment and yearly during 5 years of anti-hypertensive treatment with either an atenolol- or a losartan-based regimen. The incidence of coronary and peripheral revascularization was recorded. RESULTS: In Cox regression analyses adjusted for treatment allocation and continent, high time-varying Sokolow-Lyon voltage (hazard ratio [HR]=1.01 [1.00-1.02], p=0.01), but not time-varying Cornell product or UACR, predicted coronary revascularization together with low time-varying HDL-cholesterol, low time-varying pulse pressure, high Framingham risk score and history of angina pectoris. Adjusted for treatment allocation and continent, high time-varying Sokolow-Lyon voltage (HR=1.01 [1.00-1.03], p=0.02), but not time-varying Cornell product or UACR, predicted peripheral revascularization together with high time-varying pulse pressure, high Framingham risk score, history of peripheral vascular disease and prior myocardial infarction. CONCLUSION: Higher Sokolow-Lyon voltage during antihypertensive treatment, but not UACR or the Cornell voltage-duration product, was independently associated with higher incidence of coronary as well as peripheral revascularization.