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Circulation, Vol 90, 179-185, Copyright © 1994 by American Heart Association
WS Post, MG Larson and D Levy
BACKGROUND: Left ventricular hypertrophy is often found very early in the
course of hypertension. It is not known whether increased left ventricular
mass contributes to the pathogenesis of hypertension. The purpose of this
study was to examine the impact of left ventricular mass and other
echocardiographically assessed cardiac structural features on the incidence
of hypertension. METHODS AND RESULTS: Subjects for this investigation
included participants in the Framingham Heart Study and the Framingham
Offspring Study who were normotensive at the baseline examination (systolic
blood pressure, < 140 mm Hg; diastolic blood pressure, < 90 mm Hg;
not receiving antihypertensive medications) and free of coronary heart
disease, congestive heart failure, valvular heart disease, hypertrophic
cardiomyopathy, diabetes mellitus, and renal insufficiency. The study
sample included 1121 men (mean age, 44.4 years) and 1559 women (mean age,
45.6 years). Four years after the baseline examination, 202 men (18.0%) and
257 women (16.5%) were hypertensive (systolic blood pressure, > or = 140
mm Hg; diastolic blood pressure, > or = 90 mm Hg; or use of
antihypertensive medications). Baseline echocardiographic left ventricular
mass (P = .01) and the sum of septal and posterior left ventricular wall
thicknesses (P = .02) were associated with progression to hypertension.
After adjusting for sex, baseline age, systolic and diastolic blood
pressures, body mass index, alcohol intake, and systolic blood pressure
from an examination 8 years earlier, the odds ratio for developing
hypertension for a 1-SD increment in left ventricular mass index was 1.20
(95% confidence interval, 1.04 to 1.39), and the odds ratio for a 1-SD
increment in left ventricular wall thickness was 1.16 (95% confidence
interval, 1.02 to 1.33). CONCLUSIONS: In these normotensive adults,
increased left ventricular mass and wall thickness were associated with the
development of hypertension. Further studies are warranted to examine the
utility of echocardiography in determining the need for antihypertensive
therapy and to assess the effect of earlier intervention on the course of
progression to hypertension.
ARTICLES
Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study
Framingham Heart Study, Mass 01701.
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