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Bang C, Gerholt L, Gerdts E, Larstorp AC, Kjeldsen S, Julius S, Wachtell K, Okin P, Devereux RB. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy predicts atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently increased left atrial systolic force (LASF), a measure of left atrial function, has been associated with left ventricular hypertrophy (LVH) in hypertensive patients. Impaired left ventricular relaxation is often seen in hypertensive patients and because of the correlated left ventricular filling impairment the atrial contribution to ventricular filling is important. LASF may increase as a compensatory response to preserve a sufficient stroke volume, which partly could explain the association between age-related prolonged left ventricular relaxation and increased LASF. Reduced left atrial function has also been shown to be associated with poor prognosis in patients with atrial fibrillation. It remains unknown whether LASF can be used as a predictor of new-onset atrial fibrillation (NOAF). Furthermore, the influence of treatment with atenolol and losartan on LASF is unclear.
Purpose
We aimed to determine whether LASF correlates to incident atrial fibrillation and whether the preservation of LASF reduces the risk of new onset atrial fibrillation (NOAF).
Methods
N=758 patients without atrial fibrillation at baseline were enrolled from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography sub study. Participants of the LIFE-study were randomized to either atenolol- or losartan-based treatment. Mean follow-up was 59 month. LASF was calculated using average mitral orifice area and mitral peak A velocity obtained by Doppler echocardiography.
Results
At baseline 25% of patients had a LASF≤10.3kdyn. Compared to other quartiles this quartile had a higher proportion of men, lower heart rate, body mass index and age. After controlling for these variables patients in the first quartile had lower stroke volume compared to other quartiles. New-onset AF occurred in 29 (8.1/1,000 patients-years of follow-up) patients. In multivariable Cox regression analyses with backwards elimination increasing LASF was associated with lower risk of NOAF (HR=0.90 [95% confidence interval 0.85–0.96], p=0.001). Integrated discrimination improvement was 0.054 (p=0.004) and there was a borderline significant net reclassification improvement of 19.2% (p=0.075). Over time LASF decreased more in the atenolol-based than the losartan-based treatment group (p<0.001).
Conclusions
Low left atrial systolic force (LASF) was associated with higher risk of NOAF. Losartan-based treatment was associated with better preservation of LASF compared to atenolol-based treatment. Our data thus suggest that hypertensive patients with LVH and low LASF identifies a patient group with progressed left atrial dysfunction and with high risk of NOAF. Because of the preserving effect of losartan on the function and structure of the left atrium, treating hypertensive patients with LVH with losartan might decrease their risk of incident atrial fibrillation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The LIFE study originally received support from Merck & Co., Inc.
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Affiliation(s)
- C Bang
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | | | - E Gerdts
- University of Bergen, Haukeland Hospital, Department of Cardiology , Bergen , Norway
| | - A C Larstorp
- Oslo University Hospital Ulleval , Oslo , Norway
| | - S Kjeldsen
- Oslo University Hospital Ulleval , Oslo , Norway
| | - S Julius
- University of Michigan Hospital, Division of Cardiovascular Medicine , Ann Arbor , United States of America
| | - K Wachtell
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
| | - P Okin
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
| | - R B Devereux
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
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2
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Bang C, Greve A, Kober L, Muthiah A, Kjeldsen S, Julius S, Wachtell K, Devereux RB, Okin P. Incident atrial fibrillation and heart failure in treated hypertensive patients with left ventricular hypertrophy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension and left ventricular hypertrophy (LVH) are predictors of atrial fibrillation (AF) and heart failure (HF). The incidence rates of AF and HF and especially the combination of these two complications in hypertensive patients with LVH receiving antihypertensive treatment are unknown, and so are the association with risk levels of other cardiovascular diseases and death in hypertensive patients with LVH who develop new onset AF and HF.
Purpose
We aimed to investigate the appearance and severity of AF and HF in 8,702 hypertensive patients aged 55–80 years with LVH receiving antihypertensive treatment in a prospective and randomized clinical trial primarily designed to investigate the preventive effect on a composite endpoint of myocardial infarction, stroke and cardiovascular death.
Methods
Included were patients who had sinus rhythm in ECG and no history of AF or HF when they were randomly allocated to blinded study medication with losartan or atenolol. Additional medication was given with hydrochlorothiazide and calcium antagonist if needed to gain blood pressure control. Incident AF was detected by annual ECGs and from adverse event reports submitted by the 930 clinical investigators. Incident HF was diagnosed according to Framingham criteria. Endpoints including incident HF, myocardial infarction, stroke and cardiovascular death were reported with relevant documentation by the investigators, and adjudicated by an expert endpoint committee.
Results
Incident AF occurred in 679 patients (7.8%) and HF in 246 patients (2.8%) during 4.7±1.1 years mean follow-up. Incident AF was associated with a >4-fold increased risk of developing subsequent HF (HR=4.7; 95% CIs, 3.1–7.0; P<0.001) in multivariable Cox analyses adjusting for age, sex, race, randomized treatment, standard cardiovascular risk factors and incident myocardial infarction. The development of HF as a time-dependent variable was associated with a multivariable-adjusted 3-fold increase of the primary study endpoint (HR=3.11; 95% CIs, 1.52 to 6.39; P<0.001) which was the composite of myocardial infarction, stroke or cardiovascular death.
Incident HF was associated with a >3-fold increased risk of developing subsequent AF (HR=3.3; 95% CIs, 2.3–4.9; P<0.001). This development of AF was associated with more than a 2-fold increase of the composite of myocardial infarction, stroke or cardiovascular death in multivariable Cox analysis (HR=2.26; 95% CIs, 1.09–4.67; P=0.028).
Conclusions
Incident atrial fibrillation and heart failure are associated with increased risk of the other in treated hypertensive patients with left ventricular hypertrophy. These hypertensive patients who subsequently develop both atrial fibrillation and heart failure during antihypertensive treatment have particularly high risk of an additional composite endpoint consisting of myocardial infarction, stroke or cardiovascular death.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The study originally received support from Merck & Co., Inc.
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Affiliation(s)
- C Bang
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Greve
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry , Copenhagen , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - A Muthiah
- Akershus University Hospital , Oslo , Norway
| | - S Kjeldsen
- Oslo University Hospital Ulleval, Department of Cardiology , Oslo , Norway
| | - S Julius
- University of Michigan Health System, Division of Cardiovascular Medicine , Ann Arbor , United States of America
| | - K Wachtell
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
| | - R B Devereux
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
| | - P Okin
- Weill-Cornell Medicine, Greenberg Division of Cardiology , New York City , United States of America
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Losi MA, Mancusi C, Gerdts E, Wachtell K, Kjeldsen SE, Greve AM, Devereux RB, De Simone G. P3835Improvement of myocardial energetic efficiency during treatment in hypertensive patients: the life study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial energetic efficiency (MEE) per unit of left ventricular (LV) mass significantly predicts composite of cardiovascular (CV) events in treated hypertensive patients and specifically heart failure in an event-free population-based cohort with normal ejection fraction, independently of LV hypertrophy (LVH).
Purpose
To investigate whether MEEi changes over time in treated hypertensive patients, and whether different treatments have different effects.
Methods
From the Losartan Intervention For Endpoint study (LIFE Echo Sub-study) we selected 744 hypertensive patients (age 66±7 years; 45% women) with LVH at ECG, without atrial fibrillation, previous or incident myocardial infarction and with normal echocardiographic ejection fraction (>50%). MEE was estimated as the ratio of stroke work to the “double” product of heart rate times systolic blood pressure (BP), simplified as the ratio of stroke volume to heart rate, as previously reported. MEE was normalized for LVM (MEEi) and analyzed in quartiles at baseline and at the end treatment, according to an “intention-to-treat” protocol.
Results
Age and proportion of women were not significantly different from the highest to the lowest quartiles (from 65±7 to 66±7 years, p for trend=0.352; from 45% to 42%, p=0.946, respectively), whereas diastolic blood pressure (from 97±8 to 100±9 mmHg, p=0.006), prevalence of obesity (from 14 to 31%, p=0.001) and diabetes (from 4 to 14%, 0.004) progressively increased. Prevalence of concentric LV geometry and echocardiographic LVH also progressively increased from the highest to the lowest quartile (from 14 to 70%, and 61 to 90%, both p<0.0001). MEEi increased over time (p<0.007), independently of initial diastolic BP, diabetes and obesity, significantly more in patients treated with atenolol than with losartan (p<0.0001) (Figure), due to both increased stroke volume and decreased heart rate (both p<0.0001).
Figure 1
Conclusions
In a randomized clinical study, MEEi improves with anti-hypertensive therapy. Improvement is more evident in patients with atenolol than with losartan-based treatment, possibly providing pathophysiologic explanation of the comparable performance in prevention of ischemic heart disease previously reported in the LIFE study.
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Affiliation(s)
- M A Losi
- Federico II University of Naples, Advanced Biomedical Sciences, Naples, Italy
| | - C Mancusi
- Federico II University of Naples, Advanced Biomedical Sciences, Naples, Italy
| | - E Gerdts
- University of Bergen, Bergen, Norway
| | | | | | - A M Greve
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R B Devereux
- Weill Cornell Medical College, New York, United States of America
| | - G De Simone
- Federico II University of Naples, Advanced Biomedical Sciences, Naples, Italy
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Losi MA, Izzo R, Mancusi C, Wang W, Roman MJ, Lee ET, Howard BH, Devereux RB, De Simone G. P3192Depressed myocardial energetic efficiency is associated with increased risk of incident heart failure: the strong heart study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M A Losi
- Federico II University of Naples, Advanced Biomedical Sciences, Naples, Italy
| | - R Izzo
- Federico II University Hospital, Department of Translational Medicine, Naples, Italy
| | - C Mancusi
- Federico II University of Naples, Advanced Biomedical Sciences, Naples, Italy
| | - W Wang
- University of Oklahoma, Oklahoma City, United States of America
| | - M J Roman
- Weill Cornell Medical College, New York, United States of America
| | - E T Lee
- University of Oklahoma, Oklahoma City, United States of America
| | - B H Howard
- Medstar Research Institute, Washington, United States of America
| | - R B Devereux
- Weill Cornell Medical College, New York, United States of America
| | - G De Simone
- Federico II University of Naples, Hypertension Research Center, Naples, Italy
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Ferrara LA, Wang H, Umans JG, Franceschini N, Jolly S, Lee ET, Yeh J, Devereux RB, Howard BV, de Simone G. Serum uric acid does not predict incident metabolic syndrome in a population with high prevalence of obesity. Nutr Metab Cardiovasc Dis 2014; 24:1360-1364. [PMID: 25063537 PMCID: PMC4250289 DOI: 10.1016/j.numecd.2014.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 01/05/2023]
Abstract
AIM To evaluate whether uric acid (UA) predicts 4-yr incidence of metabolic syndrome (MetS) in non-diabetic participants of the Strong Heart Study (SHS) cohort. METHODS AND RESULTS In this population-based prospective study we analyzed 1499 American Indians (890 women), without diabetes or MetS, controlled during the 4th SHS exam and re-examined 4 years later during the 5th SHS exam. Participants were divided into sex-specific tertiles of UA and the first two tertiles (group N) were compared with the third tertile (group H). Body mass index (BMI = 28.3 ± 7 vs. 31.1 ± 7 kg/m(2)), fat-free mass (FFM = 52.0 ± 14 vs. 54.9 ± 11 kg), waist-to-hip ratio, HOMA-IR (3.66 vs. 4.26), BP and indices of inflammation were significantly higher in group H than in group N (all p < 0.001). Incident MetS at the time of the 5th exam was more frequent in group H than group N (35 vs. 28%, OR 1.44 (95% CI = 1.10-1.91; p < 0.01). This association was still significant (OR = 1.13, p = 0.04) independently of family relatedness, sex, history of hypertension, HOMA-IR, central adiposity and renal function, but disappeared when fat-free mass was included in the model. CONCLUSIONS In the SHS, UA levels are associated to parameters of insulin resistance and to indices of inflammation. UA levels, however, do not predict incident MetS independently of the initial obesity-related increased FFM.
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Affiliation(s)
- L A Ferrara
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
| | - H Wang
- MedStar Health Research Institute, Washington, D.C., USA
| | - J G Umans
- MedStar Health Research Institute, Washington, D.C., USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, D.C., USA
| | - N Franceschini
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Jolly
- General Internal Medicine, Cleveland Clinic Medicine Institute, USA
| | - E T Lee
- Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK, USA
| | - J Yeh
- Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK, USA
| | - R B Devereux
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - B V Howard
- MedStar Health Research Institute, Washington, D.C., USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, D.C., USA
| | - G de Simone
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Department of Translational Medical Sciences, Federico II University, Naples, Italy
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6
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Ferrara LA, Capaldo B, Mancusi C, Lee ET, Howard BV, Devereux RB, de Simone G. Cardiometabolic risk in overweight subjects with or without relative fat-free mass deficiency: the Strong Heart Study. Nutr Metab Cardiovasc Dis 2014; 24:271-276. [PMID: 24360764 PMCID: PMC3959567 DOI: 10.1016/j.numecd.2013.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/25/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Sarcopenia is a condition mainly due to loss of fat-free mass (FFM) in elderly individuals. RFFMD, however, is also frequent in obese subjects due to abnormal body composition. Objective of this study was to evaluate the impact of relative fat-free mass deficiency (RFFMD) on cardiometabolic (CM) risk in obese normoglycemic individuals. METHODS AND RESULTS Overweight/obese American Indians from the Strong Heart Study population, without diabetes and with FBG ≤ 110 mg/dL and with GFR >60 mg/mL/1.73 m(2) were selected for this analysis (n = 742). RFFMD was defined on the basis of a multivariable equation previously reported. Fasting glucose and 2 h-OGTT were measured together with urine albumin/creatinine excretion, laboratory and anthropometric parameters. In addition to lower FFM and greater adipose mass, participants with RFFMD had higher body mass index, waist circumference, C-reactive protein, fibrinogen, insulin resistance and urinary albumin/creatinine than participants with normal FFM (all p < 0.001); they also had a greater prevalence of hypertension, impaired glucose tolerance (IGT) or OGTT-diabetes than participants with normal FFM (all p < 0.003) and a near 2-fold greater probability of significant proteinuria (p < 0.01). RFFMD was more frequent in women than in men: significant sex-RFFMD interactions were found for BMI and waist circumference (both p < 0.0001). CONCLUSIONS RFFMD in overweight/obese normoglycemic individuals is associated with greater probability of hypertension, abnormalities of glucose tolerance and proteinuria. Assessment of RFFRMD might, therefore, help stratifying cardiometabolic risk among normoglycemic individuals with overweight/obesity.
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Affiliation(s)
- L A Ferrara
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy.
| | - B Capaldo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy
| | - C Mancusi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - E T Lee
- Center for American Indian Health Research, University of Oklahoma, Oklahoma City, OK, USA
| | - B V Howard
- Medstar Research Institute, Washington, D.C., USA
| | - R B Devereux
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - G de Simone
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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7
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Okin PM, Hille DA, Wiik BP, Kjeldsen SE, Lindholm LH, Dahlöf B, Devereux RB. In-treatment HDL cholesterol levels and development of new diabetes mellitus in hypertensive patients: the LIFE Study. Diabet Med 2013; 30:1189-97. [PMID: 23587029 DOI: 10.1111/dme.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/27/2022]
Abstract
AIMS Although hypertensive patients with low baseline HDL cholesterol levels have a higher incidence of diabetes mellitus, whether changing levels of HDL over time are more strongly related to the risk of new diabetes in hypertensive patients has not been examined. METHODS Incident diabetes mellitus was examined in relation to baseline and in-treatment HDL levels in 7485 hypertensive patients with no history of diabetes randomly assigned to losartan- or atenolol-based treatment. RESULTS During 4.7 ± 1.2 years follow-up, 520 patients (6.9%) developed new diabetes. In univariate Cox analyses, compared with the highest quartile of HDL levels (> 1.78 mmol/l), baseline and in-treatment HDL in the lowest quartile (< 1.21 mmol/l) identified patients with > 5-fold and > 9 fold higher risks of new diabetes, respectively; patients with baseline or in-treatment HDL in the 2nd and 3rd quartiles had intermediate risk of diabetes. In multivariable Cox analyses, adjusting for randomized treatment, age, sex, race, prior anti-hypertensive therapy, baseline uric acid, serum creatinine and glucose entered as standard covariates, and in-treatment non-HDL cholesterol, Cornell product left ventricular hypertrophy, diastolic and systolic pressure, BMI, hydrochlorothiazide and statin use as time-varying covariates, the lowest quartile of in-treatment HDL remained associated with a nearly 9-fold increased risk of new diabetes (hazard ratio 8.7, 95% CI 5.0-15.2), whereas the risk of new diabetes was significantly attenuated for baseline HDL < 1.21 mmol/l (hazard ratio 3.9, 95% CI 2.8-5.4). CONCLUSIONS Lower in-treatment HDL is more strongly associated with increased risk of new diabetes than baseline HDL level.
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Affiliation(s)
- P M Okin
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
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8
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Mancusi C, Gerdts E, De Simone G, Abdelhai YM, Lonnebakken MT, Boman K, Wachtell K, Dahlof B, Devereux RB. Impact of isolated systolic hypertension on normalization of left ventricular structure during antihypertensive treatment in patients with electrocardiographic left ventricular hypertrophy (LIFE). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Bang CN, Okin P, Gottlieb AB, Kober L, Wachtell K, Devereux RB. Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients. the life study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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de Simone G, Devereux RB, Roman MJ, Chinali M, Barac A, Panza JA, Lee ET, Galloway JM, Howard BV. Does cardiovascular phenotype explain the association between diabetes and incident heart failure? The Strong Heart Study. Nutr Metab Cardiovasc Dis 2013; 23:285-291. [PMID: 21940153 PMCID: PMC3246029 DOI: 10.1016/j.numecd.2011.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Diabetes remains a predictor of incident heart failure (HF), independent of intercurrent myocardial infarction (MI) and concomitant risk factors. Initial cardiovascular (CV) characteristics, associated with incident heart failure (HF) might explain the association of diabetes with incident HF. METHODS AND RESULTS Participants to the 2nd Strong Heart Study exam, without prevalent HF or coronary heart disease, or glomerular filtration rate <30 mL/min/1.73 m(2), were analyzed (n = 2757, 1777 women, 1278 diabetic). Cox regression of incident HF (follow-up 8.91 ± 2.76 years) included incident MI censored as a competing risk event. Acute MI occurred in 96 diabetic (7%) and 84 non-diabetic participants (6%, p = ns). HF occurred in 156 diabetic (12%) and in 68 non-diabetic participants (5%; OR = 2.89, p < 0.001). After accounting for competing MI and controlling for age, gender, BMI, systolic blood pressure, smoking habit, plasma cholesterol, antihypertensive treatment, heart rate, fibrinogen and C-reactive protein, incident HF was predicted by greater LV mass index, larger left atrium, lower systolic function, greater left atrial systolic force and urinary albumin/creatinine excretion. Risk of HF was reduced with more rapid LV relaxation and anti-hypertensive therapy. Diabetes increases hazard of HF by 66% (0.02 < p < 0.001). The effect of diabetes could be explained by the level of HbA1c. CONCLUSIONS Incident HF occurs more frequently in diabetes, independent of intercurrent MI, abnormal LV geometry, subclinical systolic dysfunction and indicators of less rapid LV relaxation, and is influenced by poor metabolic control. Identification of CV phenotype at high-risk for HF in diabetes should be advised.
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Affiliation(s)
- G de Simone
- Weill Cornell Medical College, New York, NY, USA.
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11
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Gerdts E, de Simone G, Lund BP, Okin PM, Wachtell K, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Impact of overweight and obesity on cardiac benefit of antihypertensive treatment. Nutr Metab Cardiovasc Dis 2013; 23:122-129. [PMID: 21775111 DOI: 10.1016/j.numecd.2011.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 02/06/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Increased body mass index (BMI) has been associated with increased cardiovascular morbidity and mortality in hypertension. Less is known about the impact of BMI on improvement in left ventricular (LV) structure and function during antihypertensive treatment. METHODS AND RESULTS Annual BMI, echocardiograms and cardiovascular events were recorded in 875 hypertensive patients with LV hypertrophy during 4.8 years randomized treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. Patients were grouped by baseline BMI into normal (n = 282), overweight (n = 405), obese (n = 150) and severely obese groups (n = 38) (BMI ≤24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2), respectively). At study end, residual LV hypertrophy was present in 54% of obese and 79% of severely obese patients compared to 31% of normal weight patients (both p < 0.01). In regression analyses, adjusting for initial LV mass/height(2.7), higher BMI predicted less LV hypertrophy reduction and more reduction in LV ejection fraction (both p < 0.05), independent of blood pressure reduction, diabetes and in-study weight change. During follow-up, 91 patients suffered cardiovascular death, myocardial infarction or stroke. In Cox regression analysis 1 kg/m(2) higher baseline BMI predicted a 5% higher rate of cardiovascular events and 10% higher cardiovascular mortality over 4.8 years (both p < 0.05). CONCLUSIONS In hypertensive patients in the LIFE study, increased BMI was associated with less reduction of LV hypertrophy and less improvement in LV systolic function which may contribute to the observed higher cardiovascular event rate of treated hypertensive patients.
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Affiliation(s)
- E Gerdts
- Institute of Medicine, University of Bergen, N-5021, Bergen, Norway.
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12
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de Simone G, Arnett DK, Chinali M, De Marco M, Rao DC, Kraja AT, Hunt SC, Devereux RB. Partial normalization of components of metabolic syndrome does not influence prevalent echocardiographic abnormalities: the HyperGEN study. Nutr Metab Cardiovasc Dis 2013; 23:38-45. [PMID: 21570269 PMCID: PMC3158296 DOI: 10.1016/j.numecd.2011.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 12/21/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) is a complex condition characterized by different phenotypes, according to the combinations of risk factors and is associated with cardiovascular abnormalities. Whether control of MetS components by treatment produces improvement in the associated cardiovascular abnormalities is unknown. We investigated whether partial control of components of MetS was associated with less echocardiographic abnormalities than the complete presentation of MetS based on measured components. METHODS AND RESULTS We evaluated markers of echocardiographic preclinical cardiovascular disease in MetS (ATP III) defined by measured components or by history of treatment, in 1421 African-American and 1195 Caucasian non-diabetic HyperGEN participants, without prevalent cardiovascular disease or serum creatinine >2 mg/dL. Of 2616 subjects, 512 subjects had MetS by measured components and 328 by history. Hypertension was found in 16% of participants without MetS, 6% of those with MetS by history and 42% of those with MetS by measured components. Obesity and central fat distribution had similar prevalence in both MetS groups (both p < 0.0001 vs. No-MetS). Blood pressure was similar in MetS by history and No-MetS, and lower than in MetS by measured components (p < 0.0001). LV mass and midwall shortening, left atrial (LA) dimension and LA systolic force were similarly abnormal in both MetS groups (all p < 0.0001 vs. No-MetS) without difference between them. CONCLUSIONS There is a little impact of control by treatment of single components of MetS (namely hypertension) on echocardiographic abnormalities. Lower blood pressure in participants with MetS by history was not associated with substantially reduced alterations in cardiac geometry and function.
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Affiliation(s)
- G de Simone
- Weill-Cornell Medical College, New York, NY, USA.
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Bahlmann E, Nienaber CA, Cramariuc D, Gohlke-Baerwolf C, Ray S, Devereux RB, Wachtell K, Kuck KH, Davidsen E, Gerdts E. Aortic root geometry in aortic stenosis patients (a SEAS substudy). European Journal of Echocardiography 2011; 12:585-90. [DOI: 10.1093/ejechocard/jer037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lynch AI, Tang W, Shi G, Devereux RB, Eckfeldt JH, Arnett DK. Epistatic effects of ACE I/D and AGT gene variants on left ventricular mass in hypertensive patients: the HyperGEN study. J Hum Hypertens 2011; 26:133-40. [PMID: 21248783 PMCID: PMC3775641 DOI: 10.1038/jhh.2010.131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Identifying predictors of left ventricular hypertrophy has been an active study topic because of its association with cardiovascular morbidity and mortality. We examined the epistatic effect (gene-gene interaction) of two genes (angiotensin-converting enzyme (ACE) insertion/deletion (I/D); angiotensinogen (AGT) -6G-A, M235T, -20A-C) in the renin-angiotensin system on left ventricular mass (LVM) among hypertensive participants in the Hypertension Genetic Epidemiology Network study. Included were 2156 participants aged 20-87 years (60% women, 63% African American). We employed mixed linear regression models to assess main effects of four genetic variants on echocardigraphically determined LVM (indexed for height), and ACE-by-AGT epistatic effects. There was evidence that AGT -6G-A was associated with LVM among white participants: adjusted mean LVM (gm(-2.7)) increased with 'G' allele copy number ('AA':41.2, 'AG':42.3, 'GG':44.0; P=0.03). There was also evidence of an ACE I/D-by-AGT -20A-C epistatic effect among white participants (interaction P=0.03): among ACE 'DD' participants, AGT -20A-C 'C' allele carriers had lower mean LVM than 'AA' homozygotes ('DD/CC':39.2, 'DD/AC':39.9, 'DD/AA':43.9), with no similar significant effect among ACE 'I' allele carriers ('ID/CC':47.2, 'ID/AC':43.4, 'ID/AA':42.6; 'II/CC': NA, 'II/AC':41.3, 'II/AA':43.1). These findings indicate that renin-angiotensin system variants in at least two genes may interact to modulate LVM.
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Affiliation(s)
- A I Lynch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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Fox ER, Klos KL, Penman AD, Blair GJ, Blossom BD, Arnett D, Devereux RB, Samdarshi T, Boerwinkle E, Mosley TH. Heritability and genetic linkage of left ventricular mass, systolic and diastolic function in hypertensive African Americans (From the GENOA Study). Am J Hypertens 2010; 23:870-5. [PMID: 20448532 DOI: 10.1038/ajh.2010.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Much of the interindividual variation in left ventricular (LV) structure and function is unexplained by established risk factors and may be due to novel or genetic factors. We used pedigree information from 454 tandem markers across the genome to estimate the heritability and linkage of various echocardiographic measures of LV structure and function in a cohort of African-American hypertensive siblings. METHODS LV mass was calculated according to the American Society of Echocardiography (ASE) simplified cubed equation and indexed to height(2.7). Fractional shortening (FS) was calculated as the percent change in the internal diameter between diastole and systole. Ejection fraction (EF) was calculated from ventricular diameters. Peak mitral early and late diastolic filling velocities were measured from the transmitral pulsed Doppler profile. The maximum-likelihood heritability estimate for each phenotype was obtained using a variance components method. Linkage analyses were performed using the multipoint variance components-based approach. RESULTS There was moderate heritability for LV mass index (34%), interventricular septal thickness (29%), diastolic diameter (42%), EF (40%), FS (39%), and mitral early and late diastolic filling velocities (37 and 45%, respectively). The greatest evidence of genetic linkage was observed for LV mass index on chromosome 3 (logarithm of odds (LOD) score = 2.38), LV EF on chromosome 12 (LOD score = 2.39), and mitral E-wave velocity (MVE) on chromosome 19 (LOD score = 2.69). CONCLUSIONS In this African-American cohort of hypertensive siblings, the greatest evidence for linkage of LV structure and function was on chromosomes 3, 12, and 19.
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Wiik BP, Larstorp ACK, Hoieggen A, Kjeldsen SE, Olsen MH, Ibsen H, Lindholm L, Dahlof B, Devereux RB, Okin PM, Wachtell K. Serum uric acid is associated with new-onset diabetes in hypertensive patients with left ventricular hypertrophy: The LIFE Study. Am J Hypertens 2010; 23:845-51. [PMID: 20431530 DOI: 10.1038/ajh.2010.89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients. METHODS In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, a double-masked, parallel-group design, 9,193 patients with hypertension and electrocardiographic LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7,489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD. RESULTS NOD developed in 522 of 7,489 patients. The association between baseline SUA and development of NOD was significant (hazard ratio (HR) 1.29 per s.d. (1.3 mg/dl), 95% confidence interval (CI) 1.18-1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow-Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18-1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per s.d. [1.3 mg/dl], 95% CI 1.02-1.19, P = 0.015). CONCLUSION Our analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.
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Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlof B, Edelman JM, Devereux RB. All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy. Eur Heart J 2010; 31:2271-9. [DOI: 10.1093/eurheartj/ehq225] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Larstorp A, Olsen MH, Okin PM, Devereux RB, Ibsen H, Dahlöf B, Kjeldsen SE, Wachtell K. REDUCED ECG-LVH DURING ANTIHYPERTENSIVE THERAPY IS ASSOCIATED WITH LESS HOSPITALIZATION FOR HEART FAILURE IN PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION. THE LIFE STUDY: 1A.01. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378236.52706.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Simone G, Okin PM, Gerdts E, Olsen MH, Wachtell K, Hille DA, Dahlöf B, Kjeldsen SE, Devereux RB. Clustered metabolic abnormalities blunt regression of hypertensive left ventricular hypertrophy: the LIFE study. Nutr Metab Cardiovasc Dis 2009; 19:634-640. [PMID: 19361968 DOI: 10.1016/j.numecd.2008.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/30/2008] [Accepted: 12/18/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome predicted outcome in the LIFE study, independently of single risk markers, including obesity, diabetes and baseline ECG left ventricular hypertrophy (LVH). We examined whether clusters of two or more metabolic abnormalities (MetAb, including obesity, high plasma glucose without diabetes, low HDL-cholesterol) in addition to hypertension were associated to levels of ECG LVH reduction comparable to that obtained in hypertensive subjects without or with only one additional metabolic abnormality (no-MetAb). METHODS AND RESULTS We studied 5558 non-diabetic participants without MetAb (2920 women) and 1235 with MetAb (751 women) from the LIFE-study cohort. MetAb was defined by reported LIFE criteria, using partition values from the ATPIII recommendations. Time-trends of Cornell voltage-duration product (CP) over 5 years was assessed using a quadratic polynomial contrast, adjusting for age, sex, prevalent cardiovascular disease and treatment arm (losartan or atenolol). At baseline, despite similar blood pressures, CP was greater in the presence than in the absence of MetAb (p<0.0001). During follow-up, despite similar reduction of blood pressure, CP decreased less in patients with than in those without MetAb, even after adjustment for the respective baseline values (both p<0.002). Losartan was more effective than atenolol in reducing CP independently of MetAb. CONCLUSIONS Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome are related to greater initial ECG LVH in hypertensive patients with value of blood pressure similar to individuals without metabolic abnormalities, and are associated with less reduction of ECG LVH during antihypertensive therapy, potentially contributing to the reported adverse prognosis of metabolic syndrome.
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Affiliation(s)
- G de Simone
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy.
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Gerdts E, Okin PM, Omvik P, Wachtell K, Dahlöf B, Hildebrandt P, Nieminen MS, Devereux RB. Impact of diabetes on treatment-induced changes in left ventricular structure and function in hypertensive patients with left ventricular hypertrophy. The LIFE study. Nutr Metab Cardiovasc Dis 2009; 19:306-312. [PMID: 19303268 DOI: 10.1016/j.numecd.2008.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 11/25/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM Diabetes is associated with left ventricular hypertrophy (LVH) and impaired systolic function in hypertensive patients, but less is known about its impact on LVH regression and functional improvement during antihypertensive treatment. METHODS AND RESULTS We performed annual echocardiography in 730 non-diabetic and 93 diabetic patients (aged 55-80 years) with hypertension and electrocardiographic LVH during 4.8-year losartan- or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Baseline mean blood pressure (BP) and LV mass did not differ between groups. Diabetic patients had higher body mass index and pulse pressure, and lower LV ejection fraction, midwall shortening, stress-corrected midwall shortening, and estimated glomerular filtration rate (all p<0.05), and were more likely to have albuminuria. Despite comparable BP reduction in diabetic and non-diabetic groups during treatment (33/18 vs. 28/16mmHg (ns)), diabetes was associated with higher prevalence of persistent LVH (47 vs. 39%, p<0.05). In multivariate analyses, diabetes independently predicted less LV mass reduction and less improvement in stress-corrected LV midwall shortening (both p<0.01). CONCLUSION Among hypertensive patients with LVH, diabetes is associated with more residual LVH and less improvement in systolic LV function by echocardiography over 4.8 years of antihypertensive treatment.
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Affiliation(s)
- E Gerdts
- Institute of Medicine, University of Bergen.
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de Simone G, Devereux RB, Chinali M, Roman MJ, Lee ET, Resnick HE, Howard BV. Metabolic syndrome and left ventricular hypertrophy in the prediction of cardiovascular events: the Strong Heart Study. Nutr Metab Cardiovasc Dis 2009; 19:98-104. [PMID: 18674890 PMCID: PMC2729242 DOI: 10.1016/j.numecd.2008.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/06/2008] [Accepted: 04/07/2008] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) is associated with increased prevalence of echocardiographic LV hypertrophy (LVH), a potent predictor of cardiovascular (CV) outcome. Whether MetS increases risk of CV events independently of presence of LVH has never been investigated. It is also unclear whether LVH predicts CV risk both in the presence and absence of MetS. METHODS AND RESULTS Participants in the 2nd Strong Heart Study examination without prevalent coronary heart disease, congestive heart failure or renal insufficiency (plasma creatinine >2.5mg/dL) were studied (n=2758; 1746 women). MetS was defined by WHO criteria. Echocardiographic LV hypertrophy was defined using population-specific cut-point value for LV mass index (>47.3g/m(2.7)). After controlling for age, sex, LDL-cholesterol, smoking, plasma creatinine, diabetes, hypertension and obesity, participants with MetS had greater probability of LVH than those without MetS (OR=1.55 [1.18-2.04], p<0.002). Adjusted hazard of composite fatal and non-fatal CV events was greater when LVH was present, in participants without (HR=2.03 [1.33-3.08]) or with MetS (HR=1.64 [1.31-2.04], both p<0.0001), with similar adjusted population attributable risk (12% and 14%). After adjustment for LVH, risk of incident CV events remained 1.47-fold greater in MetS (p<0.003), an effect, however, that was not confirmed when diabetic participants were excluded. CONCLUSION LVH is a strong predictor of composite 8-year fatal and non-fatal CV events either in the presence or in the absence of MetS and accounts for a substantial portion of the high CV risk associated with MetS.
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Affiliation(s)
- G de Simone
- Weill-Cornell Medical College, New York, NY, USA.
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Palmieri V, Bella JN, Gerdts E, Wachtell K, Papademetriou V, Nieminen MS, Dahlof B, Devereux RB. Change in pulse pressure/stroke index in response to sustained blood pressure reduction and its impact on left ventricular mass and geometry changes: the life study. Am J Hypertens 2008; 21:701-7. [PMID: 18437127 DOI: 10.1038/ajh.2008.162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In cross-sectional data in hypertensive subjects, brachial pulse pressure (PP)/Doppler stroke index (SVi), (PP/SVi) correlates weakly but significantly with left ventricular (LV) mass and relative wall thickness (RWT). METHODS In the Losartan Intervention For End-point reduction in hypertension (LIFE) study, we evaluated the impact of antihypertensive treatment on change of PP/SVi as raw indicator of systemic arterial stiffness, and further explored the impact of the change in PP/SVi on the change in LV mass and RWT. RESULTS Compared to baseline, mean PP/SVi reduction was -13% at year 1, -15% at year 2, and -16% at year 3 follow-up, and was sustained through year 4 and year 5 follow-ups; change in PP/SVi was related to increased SVi and decreased PP during the annual follow-ups, but not to LV mass change. Restricting analyses to the first two follow-ups to ensure highest statistical power, age >65 and diabetes were associated with higher PP/SVi at baseline and throughout follow-ups; black participants and women had baseline PP/SVi mean values comparable with those of their counterparts, showed blunted PP/SVi reduction after 1 year, but differences became smaller and not statistically significant at year 2 follow-up. Losartan- or atenolol-based treatments were associated with comparable reduction of PP/SVi. At year 2 follow-up, reduced PP/SVi was associated with greater reductions in mean blood pressure (BP) and heart rate and greater increase in SVi, but not with lower LV mass; RWT was lower with lower PP/SVi at year 2 follow-up. CONCLUSIONS Reduction in PP/SVi by long-term antihypertensive treatment did not have significant impact on change in LV mass index, but correlated with LV remodeling toward eccentric geometry.
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Gerdts E, Cramariuc D, de Simone G, Wachtell K, Dahlof B, Devereux RB. Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study). European Journal of Echocardiography 2008; 9:809-15. [DOI: 10.1093/ejechocard/jen155] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Okin PM, Wachtell K, Devereux RB, Nieminen MS, Oikarinen L, Viitasalo M, Toivonen L, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Kjeldsen SE, Julius S, Dahlof B. Combination of the electrocardiographic strain pattern and albuminuria for the prediction of new-onset heart failure in hypertensive patients: the LIFE study. Am J Hypertens 2008; 21:273-9. [PMID: 18219298 DOI: 10.1038/ajh.2007.66] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although albuminuria and the electrocardiographic (ECG) strain pattern each predict development of heart failure (HF), whether combining albuminuria and strain improves prediction of new HF is unclear. METHODS The relation of ECG strain and albuminuria to new-onset HF was examined in 7,786 hypertensive patients with no history of HF, who were randomly assigned to treatment with losartan or atenolol. Albuminuria was defined by a urine albumin/creatinine ratio >30.94 mg/g. RESULTS During a mean follow-up of 4.7 +/- 1.1 years, new-onset HF occurred in 231 patients (3.0%). Five-year HF rate was highest when both strain and albuminuria were present (10.4%), intermediate when only ECG strain (8.0%) or albuminuria (4.9%) was present, and lowest when neither strain nor albuminuria was present at baseline (1.8%, P < 0.0001). In Cox multivariable analyses, controlling for HF risk factors, treatment assignment and baseline severity of ECG left ventricular hypertrophy (LVH) by both Sokolow-Lyon voltage and Cornell product, ECG strain and albuminuria remained significant predictors of incident HF, with the presence of both strain and albuminuria associated with the highest risk (HR 2.8, 95% CI 1.8-4.4) and the presence of only strain (HR 2.6, 95% CI 1.7-4.0) or albuminuria (HR 2.1, 95% CI 1.5-2.8) with intermediate risk of new HF compared with the absence of both strain and albuminuria. CONCLUSIONS The combination of albuminuria and ECG strain identifies hypertensive patients at an increased risk of developing HF in the setting of aggressive blood pressure lowering, independent of treatment modality and of other risk factors for HF.
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Fossum E, Gleim GW, Kjeldsen SE, Kizer JR, Julius S, Devereux RB, Brady WE, Hille DA, Lyle PA, Dahlöf B. The effect of baseline physical activity on cardiovascular outcomes and new-onset diabetes in patients treated for hypertension and left ventricular hypertrophy: the LIFE study. J Intern Med 2007; 262:439-48. [PMID: 17875180 DOI: 10.1111/j.1365-2796.2007.01808.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Physical activity (PA) is a preventive strategy for cardiovascular disease and for managing cardiovascular risk factors. There is little information on the effectiveness of PA for the prevention of cardiovascular outcomes once cardiovascular disease is present. Thus, we studied the relationship between PA at baseline and cardiovascular events in a high-risk population. DESIGN A prespecified analyses of observational data in a prospective, randomized hypertension study. SETTING Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. SUBJECTS Hypertension and left ventricular hypertrophy (LVH) (n = 9,193). INTERVENTIONS Losartan versus atenolol. MAIN OUTCOME MEASURES Reported level of PA: never exercise, exercise <or=30 min twice per week, or exercise >30 min twice per week at baseline and after a mean of 4.8 years of treatment with losartan- versus atenolol-based therapy. Risk reductions were calculated by level of PA for the primary composite end-point and its components cardiovascular death, stroke and myocardial infarction, and also all-cause mortality and new-onset diabetes. RESULTS A modest level of PA (>30 min twice per week) was associated with significant reductions in risk for the primary composite end-point [adjusted hazard ratio (aHR) 0.70, P < 0.001) and its components, all-cause mortality (aHR 0.65, P < 0.001), and new-onset diabetes (aHR 0.66, P < 0.001). CONCLUSION A modest level of self-reported PA (>30 min twice per week) in patients with hypertension and LVH in the LIFE study was associated with significant reductions in risk for the primary composite end-point and its components of cardiovascular death, stroke, and myocardial infarction, all-cause mortality, and new-onset diabetes.
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Affiliation(s)
- E Fossum
- Ullevaal University Hospital, University of Oslo, Oslo, Norway.
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de Simone G, Olsen MH, Wachtell K, Hille DA, Dahlöf B, Ibsen H, Kjeldsen SE, Lyle PA, Devereux RB. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens 2007; 21:625-32. [PMID: 17476291 DOI: 10.1038/sj.jhh.1002203] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The relation of metabolic syndrome (MetS) with cardiovascular outcome may be less evident when preclinical cardiovascular disease is present. We explored, in a post hoc analysis, whether MetS predicts cardiovascular events in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. MetS was defined by >or=2 risk factors plus hypertension: body mass index >or=30 kg/m(2), high-density lipoprotein (HDL)-cholesterol <1.0/1.3 mmol/l (<40/50 mg/dl) (men/women), glucose >or=6.1 mmol/l (>or=110 mg/dl) fasting or >or=7.8 mmol/l (>or=140 mg/dl) nonfasting or diabetes. Cardiovascular death and the primary composite end point (CEP) of cardiovascular death, stroke and myocardial infarction were examined. In MetS (1,591 (19.3%) of 8,243 eligible patients), low HDL-cholesterol (72%), obesity (77%) and impaired glucose (73%) were similarly prevalent, with higher blood pressure, serum creatinine and Cornell product, but lower Sokolow-Lyon voltage (all P<0.001). After adjusting for baseline covariates, hazard ratios for CEPs and cardiovascular death (4.8+/-1.1 years follow-up) were 1.47 (95% confidence interval (CI), 1.27-1.71)- and 1.73 (95% CI, 1.38-2.17)-fold higher with MetS (both P<0.0001), and were only marginally reduced when further adjusted for diabetes, obesity, low HDL-cholesterol, non-HDL-cholesterol, pulse pressure and in-treatment systolic blood pressure and heart rate. Thus, MetS is associated with increased cardiovascular events in hypertensive patients with ECG-LVH, independently of single cardiovascular risk factors.
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Affiliation(s)
- G de Simone
- The Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
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Cicala S, de Simone G, Wachtell K, Gerdts E, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Clinical Impact of Changes in Wall Motion Abnormalities in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Cicala S, de Simone G, Gerdts E, Dahlöf B, Lindholm LH, Devereux RB. Are Coronary Revascularisation and Myocardial Infarction a Logical Combined Endpoint in Hypertension Trials? The Life Study. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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de Simone G, Devereux RB, Chinali M, Lee ET, Howard BV. Incident Arterial Hypertension and Left Ventricular Mass in the Presence of Initial Optimal Blood Pressure: the Strong Heart Study. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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de Simone G, Devereux RB, Chinali M, Lee ET, Howard B. Interaction of Metabolic Syndrome and Left Ventricular Hypertrophy in the Prediction of Cardiovascular Risk: the Strong Heart Study. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Okin PM, Devereux RB, Kors JA, van Herpen G, Crow RS, Fabsitz RR, Howard BV. Computerized ST depression analysis improves prediction of all-cause and cardiovascular mortality: the strong heart study. Ann Noninvasive Electrocardiol 2006; 6:107-16. [PMID: 11333167 PMCID: PMC7027664 DOI: 10.1111/j.1542-474x.2001.tb00094.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nonspecific ST depression assessed by standard visual Minnesota coding (MC) has been demonstrated to predict risk. Although computer analysis has been applied to digital ECGs for MC, the prognostic value of computerized MC and computerized ST depression analyses have not been examined in relation to standard visual MC. METHODS The predictive value of nonspecific ST depression as determined by visual and computerized MC codes 4.2 or 4.3 was compared with computer-measured ST depression >or= 50 microV in 2,127 American Indian participants in the first Strong Heart Study examination. Computerized MC and ST depression were determined using separate computerized-ECG analysis programs and visual MC was performed by an experienced ECG core laboratory. RESULTS The prevalence of MC 4.2 or 4.3 by computer was higher than by visual analysis (6.4 vs 4.4%, P < 0.001). After mean follow-up of 3.7 +/- 0.9 years, there were 73 cardiovascular deaths and 227 deaths from all causes. In univariate Cox analyses, visual MC (relative risk [RR] 4.8, 95% confidence interval [CI] 2.6-9.1), computerized MC (RR 6.0, 95% CI 3.5-10.3), and computer-measured ST depression (RR 7.6, 95% CI 4.5-12.9) were all significant predictors of cardiovascular death. In separate multivariate Cox regression analyses that included age, sex, diabetes, HDL and LDL cholesterol, body mass index, systolic and diastolic blood pressure, microalbuminuria, smoking, and the presence of coronary heart disease, computerized MC (RR 3.0, 95% CI 1.6-5.6) and computer-measured ST depression (RR 3.1, 95% CI 1.7-5.7), but not visual MC, remained significant predictors of cardiovascular mortality. When both computerized MC and computer-measured ST depression were entered into the multivariate Cox regression, each variable provided independent risk stratification (RR 2.1, 95% CI 1.0-4.4, and RR 2.1, 95% CI 1.0-4.4, respectively). Similarly, computerized MC and computer-measured ST depression, but not visual MC, were independent predictors of all-cause mortality after controlling for standard risk factors. CONCLUSIONS Computer analysis of the ECG, using computerized MC and computer-measured ST depression, provides independent and additive risk stratification for cardiovascular and all-cause mortality, and improves risk stratification compared with visual MC. These findings support the use of routine computer analysis of ST depression on the rest ECG for assessment of risk and suggest that computerized MC can replace visual MC for this purpose.
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Affiliation(s)
- P M Okin
- Department of Medicine, Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA.
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32
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Olsen MH, Wachtell K, Dahlöf B, Devereux RB, Ibsen H, Kjeldsen SE, Lindholm LH, Lyle PA, Nieminen MS. The effect of losartan compared with atenolol on the incidence of revascularization in patients with hypertension and electrocardiographic left ventricular hypertrophy. The LIFE study. J Hum Hypertens 2006; 20:460-4. [PMID: 16572193 DOI: 10.1038/sj.jhh.1002013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Carter EA, MacCluer JW, Dyke B, Howard BV, Devereux RB, Ebbesson SOE, Resnick HE. Diabetes mellitus and impaired fasting glucose in Alaska Eskimos: the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. Diabetologia 2006; 49:29-35. [PMID: 16369773 DOI: 10.1007/s00125-005-0071-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 09/19/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We aimed to: (1) define the prevalence of type 2 diabetes and IFG in Eskimos in Norton Sound, Alaska; (2) determine correlates of prevalent diabetes in this population; and (3) compare the prevalence of diabetes in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study with other samples of Eskimos, Inuit, American Indians and US blacks, whites and Mexican Americans. METHODS The GOCADAN Study enrolled 1,214 participants >or=18 years who were members of extended pedigrees from the Norton Sound region of Alaska. Diagnosed type 2 diabetes was based on reported use of insulin or hypoglycaemic medications and a medication inventory. Fasting glucose measurements were obtained to ascertain IFG status and undiagnosed diabetes according to American Diabetes Association (ADA) criteria. OGTTs were performed to ascertain diabetes according to the World Health Organization (WHO) definition. We used logistic regression analysis to model factors that were significantly associated with odds of prevalent ADA diabetes. RESULTS The prevalences of ADA diabetes and IFG were 3.8% (5.0% of women; 2.2% of men) and 15.6% (13.9% of women; 17.7% of men), respectively. In the subset of 787 participants who took the OGTT, the prevalences of ADA and WHO diabetes were 5.1 and 6.9%, respectively. The adjusted odds of ADA diabetes was 2.8 times higher in participants meeting Adult Treatment Panel III criteria for abdominal obesity than in those who did not. The statistically significant sex-related difference in diabetes prevalence did not persist in multivariable analyses. CONCLUSIONS/INTERPRETATION Alaska Eskimos have a low prevalence of type 2 diabetes. The high prevalence of IFG indicates that diabetes may become increasingly problematic in this population. Abdominal obesity in women may help explain why diabetes prevalence differs according to sex.
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Affiliation(s)
- E A Carter
- Department of Epidemiology and Statistics, MedStar Research Institute, 6495 New Hampshire Avenue, Suite 201, Hyattsville, MD 20783, USA
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Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wan Y. Reducing Microalbuminuria—Does It Lower Cardiovascular Risk? J Am Soc Nephrol 2005; 16:2521-2527. [PMID: 36996483 DOI: 10.1681/01.asn.0000926736.37167.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
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Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wan Y. Lowering Albuminuria—Does It Lower the Cardiovascular Risk? J Am Soc Nephrol 2005; 16:2247-2250. [PMID: 36996478 DOI: 10.1681/01.asn.0000926732.38641.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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36
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Hildebrandt P, Wachtell K, Dahlöf B, Papademitriou V, Gerdts E, Giles T, Oikarinen L, Tuxen C, Olsen MH, Devereux RB. Impairment of cardiac function in hypertensive patients with Type 2 diabetes: a LIFE study. Diabet Med 2005; 22:1005-11. [PMID: 16026365 DOI: 10.1111/j.1464-5491.2005.01564.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Type 2 diabetic patients with hypertension have an increased left ventricular (LV) mass and impaired cardiac function compared to hypertensive patients without diabetes. However, it is unknown if the impaired cardiac function can be explained solely by LV hypertrophy, or is independently related to diabetes. The aim of the present study was to compare LV function between diabetic and non-diabetic hypertensive patients with electrocardiographic LV hypertrophy. METHODS In 937 patients participating in the LIFE echocardiographic substudy, all echocardiograms were centrally evaluated by a core reading centre measuring LV mass, systolic and diastolic LV function. Known diabetes was present in 105 patients. RESULTS Left ventricular mass was similar in diabetic and non-diabetic patients. Endocardial systolic LV function, estimated by LV ejection fraction, was reduced and indices of midwall systolic LV function were impaired in the diabetic patients. Diastolic LV filling pattern was impaired and arterial stiffness, measured by pulse pressure/stroke index, was increased in diabetic patients. CONCLUSIONS Systolic and diastolic LV function in hypertensive patients with electrocardiographic LV hypertrophy and diabetes are impaired independent of LV mass, most likely reflecting the adverse effects of diabetes per se.
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Affiliation(s)
- P Hildebrandt
- Frederiksberg University Hospital, Frederiksberg, Denmark.
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37
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Olsen MH, Christensen MK, Wachtell K, Tuxen C, Fossum E, Bang LE, Wiinberg N, Devereux RB, Kjeldsen SE, Hildebrandt P, Dige-Petersen H, Rokkedal J, Ibsen H. Markers of collagen synthesis is related to blood pressure and vascular hypertrophy: a LIFE substudy. J Hum Hypertens 2005; 19:301-7. [PMID: 15647776 DOI: 10.1038/sj.jhh.1001819] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiac fibrosis and high levels of circulating collagen markers has been associated with left ventricular (LV) hypertrophy. However, the relationship to vascular hypertrophy and blood pressure (BP) load is unclear. In 204 patients with essential hypertension and electrocardiographic LV hypertrophy, we measured sitting BP, serum collagen type I carboxy-terminal telopeptide (ICTP) reflecting degradation, procollagen type I carboxy-terminal propeptide (PICP) reflecting synthesis and LV mass by echocardiography after 2 weeks of placebo treatment and after 1 year of antihypertensive treatment with a losartan- or an atenolol-based regimen. Furthermore, we measured intima-media thickness of the common carotid arteries (IMT), minimal forearm vascular resistance (MFVR) by plethysmography and ambulatory 24-h BP in around half of the patients. At baseline, PICP/ICTP was positively related to IMT (r=0.24, P<0.05), MFVR(men) (r=0.35, P<0.01), 24-h systolic BP (r=0.24, P<0.05) and 24-h diastolic BP (r=0.22, P<0.05), but not to LV mass. After 1 year of treatment with reduction in systolic BP (175+/-15 vs 151+/-17 mmHg, P<0.001) and diastolic BP (99+/-8 vs 88+/-9 mmHg, P<0.001), ICTP was unchanged (3.7+/-1.4 vs 3.8+/-1.4 microg/l, NS) while PICP (121+/-39 vs 102+/-29 microg/l, P<0.001) decreased. The reduction in PICP/ICTP was related to the reduction in sitting diastolic BP (r=0.31, P<0.01) and regression of IMT (r=0.37, P<0.05) in patients receiving atenolol and to reduction in heart rate in patients receiving losartan (r=0.30, P<0.01). In conclusion, collagen markers reflecting net synthesis of type I collagen were positively related to vascular hypertrophy and BP load, suggesting that collagen synthesis in the vascular wall is increased in relation to high haemodynamic load in a reversible manner.
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Affiliation(s)
- M H Olsen
- Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Denmark.
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Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, Devereux RB. Cardiac Features of Obesity in a Population of Adolescents. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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39
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Chinali M, de Simone G, Roman MJ, Bella JN, Liu JE, Lee ET, Best LG, Howard BV, Devereux RB. Impact of Left Atrial Function on Cardiovascular Phenotype and Outcome in Arterial Hypertension. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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40
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Dahlöf B, Burke TA, Krobot K, Carides GW, Edelman JM, Devereux RB, Diener HC. Population impact of losartan use on stroke in the European Union (EU): projections from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. J Hum Hypertens 2004; 18:367-73. [PMID: 15029217 DOI: 10.1038/sj.jhh.1001710] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study was designed to compare losartan- vs atenolol-based antihypertensive treatment on cardiovascular morbidity and mortality in a population of 9193 hypertensive patients with left ventricular hypertrophy (LVH). In LIFE, the losartan-based treatment further reduced the primary composite end point (cardiovascular death, myocardial infarction, or stroke) by 13% (risk reduction (RR) 0.87, 95% confidence interval (CI) 0.77-0.98, P=0.021). The further reduction in stroke with losartan (RR 0.75, 95% CI 0.63-0.89, P=0.001) was the major contributing factor to the reduction in the primary end point. Our objective was to project the reduction in stroke observed with a losartan- vs an atenolol-based antihypertensive treatment regimen in the LIFE study to the European Union (EU) population. The number of stroke events averted was estimated by identifying the number of persons in the EU expected to meet the LIFE inclusion criteria, and multiplying this figure by the cumulative incidence risk difference in stroke from LIFE at 5.5 years. The age- and gender-specific prevalence of hypertension, electrocardiographically (ECG)-diagnosed LVH among those with hypertension (inclusion criteria), and heart failure among those with LVH and hypertension (exclusion criteria) were applied to the EU census estimates. We conservatively projected that an estimated 7.8 million individuals aged 55-80 years in the EU are affected by hypertension and ECG-diagnosed LVH. Use of a losartan-based antihypertensive treatment in this population is projected to prevent approximately 125 000 first strokes over a 5.5-year period. A population-wide prevention strategy of using losartan in patients with LVH and hypertension has the potential to have a major public health impact by reducing the morbidity and mortality of stroke in the EU.
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Affiliation(s)
- B Dahlöf
- Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
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41
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Okin PM, Devereux RB, Liu JE, Oikarinen L, Jern S, Kjeldsen SE, Julius S, Wachtell K, Nieminen MS, Dahlöf B. Regression of electrocardiographic left ventricular hypertrophy predicts regression of echocardiographic left ventricular mass: the LIFE study. J Hum Hypertens 2004; 18:403-9. [PMID: 15057252 DOI: 10.1038/sj.jhh.1001707] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The electrocardiogram (ECG) is widely used for detection of left ventricular hypertrophy (LVH). However, whether changes in ECG LVH during antihypertensive therapy predict changes in LV mass remains unclear. Baseline and year-1 ECGs and echocardiograms were assessed in 584 hypertensive patients with ECG LVH by Sokolow-Lyon or Cornell voltage-duration product criteria at entry into the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic substudy. A >/=25% decrease in Cornell product defined regression of ECG LVH; a <25% decrease defined no significant regression; and an increase defined progression of ECG LVH. Regression of echocardiographic LVH was defined by a >/=20% reduction in LV mass. After 1 year of therapy, 155 patients (27%) had regression of ECG LVH, 286 (49%) had no significant change, and 143 (25%) had progression of ECG LVH. Compared with patients with progression of ECG LVH, patients with no significant decrease and patients with regression of ECG LVH had stepwise greater absolute decreases in LV mass (-16+/-33 vs -29+/-37 vs -32+/-41 g, P<0.001), greater percent reductions in LV mass (-5.7+/-14.6 vs -11.3+/-13.6 vs -12.3+/-15.6%, P<0.001), and were more likely to decrease LV mass by >/=20% (11.2 vs 24.8 vs 36.1%, P<0.001), even after adjusting for possible effects of baseline and change in systolic and diastolic pressures. Compared with progression of ECG LVH, regression of the Cornell product ECG LVH is associated with greater reduction in LV mass and a greater likelihood of regression of anatomic LVH.
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Affiliation(s)
- P M Okin
- Department of Medicine, Division of Cardiology, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Palmieri V, Wachtell K, Bella JN, Gerdts E, Papademetriou V, Nieminen MS, Dahlöf B, Roman MJ, Devereux RB. Usefulness of the assessment of the appropriateness of left ventricular mass to detect left ventricular systolic and diastolic abnormalities in absence of echocardiographic left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:423-30. [PMID: 15002006 DOI: 10.1038/sj.jhh.1001719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Conventional definitions of left ventricular (LV) hypertrophy do not account for interindividual differences in loading conditions. We may define LV mass as inappropriately high when exceeding 128% of theoretical values predicted by gender, height(2.7), and stroke work, which explain up to 82% of the variability of LV mass in normal reference subjects. In 652 participants in the Losartan Intervention For Endpoint reduction in hypertension study without clinically overt cardiovascular disease or diabetes, we investigated whether inappropriately high LV mass is associated with relevant LV abnormalities independent of traditional definition of LV hypertrophy (ie, LV mass index >116 g/m(2) in men and >104 g/m(2) in women). The study sample was divided into three groups: patients with inappropriately high LV mass but without LV hypertrophy were compared to patients with LV hypertrophy and to patients with appropriate LV mass and without LV hypertrophy. Patients with inappropriately high but nonhypertrophic LV mass had higher body mass index and relative wall thickness, and lower LV myocardial systolic function, than patients with appropriate LV mass or patients with LV hypertrophy. In multivariate analyses, inappropriately high LV mass was independently associated with lower myocardial systolic function independent of LV hypertrophy and other covariates. Inappropriately high LV mass was also associated with prolonged isovolumic relaxation time and lower mitral E/A ratio independent of covariates. In conclusion, inappropriately high LV mass was associated with relevant, often preclinical, manifestations of cardiac disease in the absence of traditionally defined echocardiographic LV hypertrophy and concentric geometry.
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Affiliation(s)
- V Palmieri
- Weill Medical College of Cornell University, New York, NY 10021, USA.
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43
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Gerdts E, Roman MJ, Palmieri V, Wachtell K, Smith G, Nieminen MS, Dahlöf B, Devereux RB. Impact of age on left ventricular hypertrophy regression during antihypertensive treatment with losartan or atenolol (the LIFE study). J Hum Hypertens 2004; 18:417-22. [PMID: 15103312 DOI: 10.1038/sj.jhh.1001718] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To assess the influence of age on changes in left ventricular (LV) mass and geometry during antihypertensive treatment, we related age to clinical and echocardiographic findings before and after 4 years of antihypertensive treatment in a subset of 560 hypertensive patients without known concurrent disease in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, which randomized patients to blinded losartan- or atenolol-based treatment. Patients >/=65 years (older group) included more women and patients with isolated systolic hypertension or albuminuria (all P<0.05). Compared to patients <65 years, older patients had higher pulse pressure, LV mass, and prevalence of concentric hypertrophy at baseline (78 vs 69 mmHg, 234 vs 224 g, and 28 vs 16%, respectively, all P<0.01), while the mean blood pressure did not differ. Over 4 years, reductions in LV mass and the mean blood pressure were similar in both groups, but older patients more often had residual hypertrophy (31 vs 15%, P<0.001) with a preponderance of eccentric geometry. In multivariate analysis of 4-year change in LV mass controlling for baseline mass, larger hypertrophy reduction was associated with losartan treatment, while age, gender, body mass index, and 4-year change in pulse pressure and albuminuria did not enter (Multiple R (2)=0.40, P<0.001). Thus, in up-to-80-year-old hypertensive patients with left ventricular hypertrophy, age did not significantly attenuate hypertrophy reduction during antihypertensive treatment, although residual hypertrophy was more prevalent in older patients as a consequence of higher initial LV mass.
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Affiliation(s)
- E Gerdts
- Institute of Medicine, University of Bergen, Norway.
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44
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Reims HM, Kjeldsen SE, Brady WE, Dahlöf B, Devereux RB, Julius S, Beevers G, De Faire U, Fyhrquist F, Ibsen H, Kristianson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H. Alcohol consumption and cardiovascular risk in hypertensives with left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:381-9. [PMID: 15103313 DOI: 10.1038/sj.jhh.1001731] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Losartan Intervention For End point reduction in hypertension (LIFE) study showed superiority of losartan over atenolol for reduction of composite risk of cardiovascular death, stroke, and myocardial infarction in hypertensives with left ventricular hypertrophy. We compared hazard ratios (HR) in 4287 and 685 participants who reported intakes of 1-7 and >8 drinks/week at baseline, respectively, with those in 4216 abstainers, adjusting for gender, age, smoking, exercise, and race. Within categories, clinical baseline characteristics, numbers randomized to losartan and atenolol, and blood pressure (BP) lowering were similar on the drug regimens. Overall BP control (<140/90 mmHg) at end of follow-up was similar in the categories. Composite end point rate was lower with 1-7 (24/1000 years; HR 0.87, P<0.05) and >8 drinks/week (26/1000 years; HR 0.80, NS) than in abstainers (27/1000 years). Myocardial infarction risk was reduced in both drinking categories (HR 0.76, P<0.05 and HR 0.29, P<0.001, respectively), while stroke risk tended to increase with >8 drinks/week (HR 1.21, NS). Composite risk was significantly reduced with losartan compared to atenolol only in abstainers (HR 0.81 95% confidence interval, CI (0.68, 0.96), P<0.05), while benefits for stroke risk reduction were similar among participants consuming 1-7 drinks/week (HR 0.73, P<0.05) and abstainers (HR 0.72, P<0.01). Despite different treatment benefits, alcohol-treatment interactions were nonsignificant. In conclusion, moderate alcohol consumption does not change the marked stroke risk reduction with losartan compared to atenolol in high-risk hypertensives. Alcohol reduces the risk of myocardial infarction, while the risk of stroke tends to increase with high intake.
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Affiliation(s)
- H M Reims
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.
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45
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Olsen MH, Wachtell K, Bella JN, Palmieri V, Gerdts E, Smith G, Nieminen MS, Dahlöf B, Ibsen H, Devereux RB. Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE substudy. J Hum Hypertens 2004; 18:453-9. [PMID: 15085167 DOI: 10.1038/sj.jhh.1001711] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We wanted to investigate whether urine albumin/creatinine ratio (UACR) and left ventricular (LV) mass, both being associated with diabetes and increased blood pressure, predicted cardiovascular events in patients with hypertension independently. After 2 weeks of placebo treatment, clinical, laboratory and echocardiographic variables were assessed in 960 hypertensive patients from the LIFE Echo substudy with electrocardiographic LV hypertrophy. Morning urine albumin and creatinine were measured to calculate UACR. The patients were followed for 60+/-4 months and the composite end point (CEP) of cardiovascular (CV) death, nonfatal stroke or nonfatal myocardial infarction was recorded. The incidence of CEP increased with increasing LV mass (below the lower quartile of 194 g to above the upper quartile of 263 g) in patients with UACR below (6.7, 5.0, 9.1%) and above the median value of 1.406 mg/mmol (9.7, 17.0, 19.0%(***)). Also the incidence of CV death increased with LV mass in patients with UACR below (0, 1.4, 1.3%) and above 1.406 mg/mmol (2.2, 6.4, 8.0%(**)). The incidence of CEP was predicted by logUACR (hazard ratio (HR)=1.44(**) for every 10-fold increase in UACR) after adjustment for Framingham risk score (HR=1.05(***)), history of peripheral vascular disease (HR=2.3(*)) and cerebrovascular disease (HR=2.1(*)). LV mass did not enter the model. LogUACR predicted CV death (HR=2.4(**)) independently of LV mass (HR=1.01(*) per gram) after adjustment for Framingham risk score (HR=1.05(*)), history of diabetes mellitus (HR=2.4(*)) and cerebrovascular disease (HR=3.2(*)). (*)P<0.05, (**)P<0.01, (***)P<0.001. In conclusion, UACR predicted CEP and CV death independently of LV mass. CV death was predicted by UACR and LV mass in an additive manner after adjustment for Framingham risk score and history of CV disease.
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Affiliation(s)
- M H Olsen
- Department of Clinical Physiology and Nuclear Medicine, Glostrup University Hospital, Glostrup, Denmark.
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Li ZB, Wachtell K, Okin PM, Gerdts E, Liu JE, Nieminen MS, Jern S, Dahlöf B, Devereux RB. Association of left bundle branch block with left ventricular structure and function in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:397-402. [PMID: 15071485 DOI: 10.1038/sj.jhh.1001709] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electrocardiographic (ECG) left bundle branch block (LBBB) is associated with left ventricular hypertrophy (LVH), but its relation to left ventricular (LV) geometry and function in hypertensive patients with ECG LVH is unknown. Echocardiograms were performed in 933 patients (548 women, mean age 66+/-7 years) with essential hypertension and LVH by baseline ECG in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. LBBB, defined by Minnesota code 7.1, was present in 47 patients and absent in 886 patients. Patients with and without LBBB were similar in age, gender, body mass index, blood pressure, prevalence of diabetes, and history of myocardial infarction. Despite similarly elevated mean LV mass (126+/-25 vs 124+/-26 g/m(2)) and relative wall thickness (0.41+/-0.07 vs 0.41+/-0.07, P=NS), patients with LBBB had lower LV fractional shortening (30+/-6 vs 34+/-6%), ejection fraction (56+/-10 vs 61+/-8%), midwall shortening (14+/-2 vs 16+/-2%), stress-corrected midwall shortening (90+/-13 vs 97+/-13%) (all P<0.001), and lower LV stroke index (38+/-7 vs 42+/-9 ml/m(2)) (P<0.05). Patients with LBBB also had reduced LV inferior wall and lower mitral E/A ratio (0.75+/-0.18 vs 0.87+/-0.38) (all P<0.05). The above univariate results were confirmed by multivariate analyses adjusted for gender, age, blood pressures, height, weight, body mass index, heart rate, and LV mass index. Among hypertensive patients at high risk because of ECG LVH, the presence of LBBB identifies individuals with worse global and regional LV systolic function and impaired LV relaxation without more severe LVH by echocardiography.
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Affiliation(s)
- Z B Li
- Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA
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47
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Wiinberg N, Bang LE, Wachtell K, Larsen J, Olsen MH, Tuxen C, Hildebrandt PR, Rokkedal J, Ibsen H, Devereux RB. 24-h Ambulatory blood pressure in patients with ECG-determined left ventricular hypertrophy: left ventricular geometry and urinary albumin excretion—a LIFE substudy. J Hum Hypertens 2004; 18:391-6. [PMID: 15057254 DOI: 10.1038/sj.jhh.1001717] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study was undertaken to evaluate the relationships among left ventricular (LV) geometric patterns and urinary albumin excretion in patients with hypertension and electrocardiographic (ECG) LV hypertrophy. In 143 patients with stage II-III hypertension, 24-h ambulatory blood pressure (BP) monitoring, single urine albumin determination, and echocardiography were performed after 14 days of placebo treatment. Mean age was 68+/-7 years, 35% were women, body mass index was 28+/-5 kg/m(2), LV mass index (LVMI) was 125+/-26 g/m(2), and 24% had microalbuminuria. The mean office BP was 176+/-15/99+/-8 mmHg and the mean daytime ambulatory BP was 161+/-18/92+/-12 mmHg. Ambulatory BP, but not office BP, was higher among albuminuric compared to normoalbuminuric patients. In patients with established hypertension, daytime pulse pressure and office BP were different in the four patterns of LV geometry, with the highest pressure in those with abnormal geometry. Furthermore, microalbuminuria was more frequent in hypertensive patients with LV hypertrophy than in those with either normal geometry or concentric remodelling. White coat hypertensives (10%) showed lower LVMI and no microalbuminuria compared to patients with established hypertension. There were no differences in the prevalence of nondippers (26%) among the four LV geometric patterns or in microalbuminuria. In conclusion, increased daytime pulse pressure and office BP were associated with increased prevalence of abnormal LV geometry. Microalbuminuria was more frequent in groups with concentric and eccentric LV hypertrophy. Ambulatory BP, but not office BP, was higher in albuminuric than normoalbuminuric patients. With regard to the relationship among BP, LV geometric patterns, and urine albumin excretion in this population, 24-h ambulatory BP did not provide additional information beyond the office BP.
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Affiliation(s)
- N Wiinberg
- Department of Clinical Physiology and Nuclear Medicine, Frederiksberg University Hospital, Frederiksberg, Denmark.
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48
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Bella JN, Palmieri V, Wachtell K, Liu JE, Gerdts E, Nieminen MS, Koren MJ, Zabalgoitia M, Wright JT, Dahlöf B, Devereux RB. Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study. J Hum Hypertens 2004; 18:411-6. [PMID: 15042116 DOI: 10.1038/sj.jhh.1001708] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While left ventricular (LV) structure and function differ between hypertensive women and men, it remains unclear whether sex affects regression of LV hypertrophy with antihypertensive treatment. We analysed paired echocardiograms in 500 men and 347 women enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study at baseline and after 12 months of antihypertensive treatment with either losartan or atenolol. At enrollment, 177 women and 242 men were randomized to losartan-based treatment and 161 women and 247 men were randomized to atenolol-based treatment (sex difference=NS). After 12 months of antihypertensive treatment, blood pressure was lowered similarly in women (152/83 from 174/97 mmHg) and men (149/85 from 173/99 mmHg; both P<0.001, sex difference=NS), without significant change in body weight in either sex. Cardiac output and pulse pressure/stroke volume were equivalently reduced in both sexes (-0.2 vs -0.1 l/min and both -0.20 mmHg/ml/m(2), respectively; both P=NS). Absolute LV mass change after 12 months of antihypertensive treatment was greater in men than in women (-30 vs -24 g, P=0.01). However, after adjusting for baseline LV mass and randomized study treatment, LV mass reduction was greater in women than in men (-33 vs -23 g, P=0.001). LV mass regression was greater in women, by 8.0+/-2.8 g, after adjusting for baseline LV mass and randomized study treatment. After consideration of baseline LV mass and randomized study treatment, antihypertensive treatment regressed LV hypertrophy more in women. Further studies are needed to identify the mechanisms and prognostic implications of this sex-related difference.
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Affiliation(s)
- J N Bella
- Weill Medical College of Cornell University, New York, NY, USA.
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49
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Kontos J, Papademetriou V, Wachtell K, Palmieri V, Liu JE, Gerdts E, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hum Hypertens 2004; 18:431-6. [PMID: 15042117 DOI: 10.1038/sj.jhh.1001715] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1+) valvular regurgitation, and 51 patients had moderate (2+ or 3+) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, P<0.05), higher LV mass indexed for body surface area (122 vs 125 g/m(2), P<0.05) or height(2.7) (55.4 vs 57.3, P<0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, P<0.001), greater mean LV mass (232 vs 248 g, P<0.001) and LV mass indexed for body surface area or height(2.7), and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.
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Affiliation(s)
- J Kontos
- VA Medical Center, Washington, DC 20422, USA.
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Olsen MH, Wachtell K, de Simone G, Palmieri V, Dige-Petersen H, Devereux RB, Ibsen H, Rokkedal J. Is inappropriate left ventricular mass related to neurohormonal factors and/or arterial changes in hypertension? a LIFE substudy. J Hum Hypertens 2004; 18:437-43. [PMID: 15014540 DOI: 10.1038/sj.jhh.1001720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We investigated whether inappropriately high left ventricular (LV) mass, defined as observed LV mass exceeding the level of individual LV mass predicted from gender, height, and stroke work, may be associated with an imbalance between growth-promoting and growth-inhibitory factors and/or structural vascular changes. In 53 patients with hypertension and electrocardiographic LV hypertrophy, 24-h ambulatory blood pressure (BP); echocardiographic LV mass, stroke volume and stroke work; minimal forearm vascular resistance (MFVR); and intima-media cross-sectional area in common carotid arteries (IMA) were evaluated after 2 weeks of placebo treatment. Serum insulin, plasma epinephrine, norepinephrine, endothelin, angiotensin II, aldosterone, and brain natriuretic peptide (BNP) were also measured. High observed LV mass was related to high IMA (r=0.46, P<0.001), MFVR (in men: r=0.36, P<0.05), 24-h ambulatory systolic BP (r=0.30, P=0.06), and lower plasma angiotensin II (r=-0.33, P<0.05), but not to other circulating growth factors. Stroke work was similarly related to IMA (r=0.42, P<0.01), MFVR (in men: r=0.41, P<0.05), and plasma angiotensin II (r=-0.32, P<0.05). Inappropriate LV mass, identified by the ratio between observed LV mass and the value predicted for gender, height, and stroke work, was not significantly related to any of the arterial or neurohormonal variables. In this small series of older hypertensive patients, inappropriate LV mass was not significantly related to arterial changes or to measured circulating growth factors, although weak relations cannot be excluded. Alternatively, inappropriately high LV mass might be related to unmeasured factors such as local myocardial alterations in growth factors and/or genetic predisposition to develop excessive LV hypertrophy.
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Affiliation(s)
- M H Olsen
- Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
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