Improving cardiovascular risk stratification in essential hypertensive patients by indexing left ventricular mass to height2.7

Abstract

Clinical abnormalities associated with left ventricular hypertrophy (LVH) only defined by left ventricular mass (LVM) indexed to height2.7 are still undefined. We investigated the prevalence, clinical correlates and extracardiac organ damage of such a cardiac phenotype in essential hypertensive patients. Subclinical organ damage was searched in 3719 untreated and treated hypertensive patients. LVH was defined by two sets of sex-specific criteria, namely, LVM indexed to height2.7 (left ventricular mass index >49/45 g/m2.7 in men and women, respectively) and LVM indexed to body surface area (BSA; left ventricular mass index >125/110 g/m2 in men and women, respectively). Patients were categorized into three groups, according to the absence of LVH by both criteria (n = 1912, group I), presence of LVH by the height2.7 criterion only (n = 784, group II) and presence of LVH by both criteria (n = 997, group III). A fourth group (n = 26, <1%), positive for LVH only by the BSA criterion, was excluded from the analysis as being too small. Group II included a higher number of female, obese patients and individuals with metabolic syndrome than the other groups. Moreover, in group II, absolute LVM values and the extent of extracardiac organ damage, as assessed by carotid intima–media thickness, carotid plaques, microalbuminuria and retinal changes were intermediate between group I and III. Our data indicate that a consistent portion of essential hypertensive patients are positive for LVH by the criterion of LVM indexed to height2.7, but not to BSA; this population is characterized by an unhealthy metabolic profile as well as by the presence of extracardiac organ damage. They also suggest that, in order to improve cardiovascular stratification, LVM should be routinely indexed to both BSA and height2.7 and patients categorized according to the consistency of both criteria.