CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 3, April 2012
AFRICA
149
and 13 months of antihypertensive treatment. Treatment resulted
in a decreased LVM and LVMI, largely through reductions in
wall thickness and only minor decreases in internal diameters.
Treatment produced maximal decreases in LVM, LVMI and
LV wall thickness, and a maximal decrease in the proportion of
patients with LVH or an increased relative wall thickness by four
months of therapy, with no further changes occurring over the
following nine months of therapy.
Fig. 1 shows the changes in prevalence of a normal left
ventricle, concentric LVH, concentric LV remodelling and
eccentric LVH after four and 13 months of antihypertensive
therapy. The proportion of patients with concentric LVH
decreased from 51.5 to 25% (
p
<
0.01), while the proportion with
concentric LV remodelling increased from 12 to 23% (
p
<
0.05).
The proportion of patients with eccentric LVH increased from 19
to 25% but this did not achieve significance. The proportion of
patients with a normal left ventricle increased from 17.5 to 26%
but this also failed to achieve significance.
From the 53 (51.5%) patients with concentric LVH at
baseline, only seven (13%) normalised the LV structure, but
15 (28%) changed to eccentric LVH, 13 (24.5%) to concentric
LV remodelling and 18 (34%) remained in the concentric LVH
TABLE 1. BASELINE CHARACTERISTICS OF PATIENTS GROUPEDACCORDINGTO LEFTVENTRICULAR STRUCTURE
Geometry
Geometry
Normal
Concentric LVH Concentric remodelling
Eccentric LVH
Number (%)
18 (17.5)
53 (51.5)**
12 (12)
20 (19)
BMI (kg/m
2
)
28.6
±
7.8
32.4
±
5.1**
28.0
±
3.1
31.7
±
6.7**
Age (years)
51.9
±
9.7
52.4
±
9.2
48.3
±
10.2
50.1
±
10.3
Female gender [
n
(%)]
14 (78)
44 (83)
10 (83)
17 (85)
24-hour SBP (mmHg)
146
±
11
158
±
16**
148
±
20
147
±
11
24-hour DBP (mmHg)
96
±
7
98
±
6
94
±
8
96
±
7
Clinic SBP (mmHg)
164
±
19
178
±
20*
161
±
25
168
±
17
Clinic DBP (mmHg)
99
±
2
104
±
9
100
±
9
101
±
9
Clinic PP (mmHg)
65.7
±
16.1
73.5
±
16.7**
60.2
±
20.0
67.6
±
15.1
24-hour PP (mmHg)
50.5
±
8.9
59.4
±
11.8*
53.1
±
15.3
52.1
±
9.5
LVM (g)
151
±
29
248
±
62**
159
±
32
222
±
36**
LVMI (g/m
2.7
)
42.8
±
8.8
74.3
±
16.5**
44.0
±
3.4
66.0
±
11.7**
LV mean wall thickness (mm)
9.4
±
1.2
11.4
±
1.6**
11.5
±
1.4**
11.0
±
1.1**
LV relative wall thickness (ratio)
0.38
±
0.06
0.56
±
0.10
0.56
±
0.10
0.39
±
0.04**
BMI, body mass index; LV, left ventricular; LVH, left ventricular hypertrophy; SBP, systolic blood pressure; DBP, diastolic BP; PP, pulse pressure;
LVM, left ventricular mass; LVMI, left ventricular mass index.
*
p
<
0.05, **
p
<
0.01 for comparisons between the four left ventricular geometric patterns.
TABLE 2. BLOOD PRESSUREAND ECHOCARDIOGRAPHICVALUESAT BASELINE
ANDAFTER FOURAND 13 MONTHS OF TREATMENT (
n
=
103)
Baseline
4 months
13 months
Clinic SBP/DBP (mmHg)
171
±
21/102
±
10
148
±
21/91
±
11**
135
±
19/85
±
10**
Clinic heart rate (beats/min)
71
±
10
72
±
10
72
±
11
24-hour SBP/DBP (mmHg)
152
±
16/97
±
7
129
±
15/87
±
9**
127
±
12/80
±
8**
24-hour heart rate (beats/min)
77
±
9
76
±
10
75
±
10
Clinic BP control
†
[
n
(%)]
0
47 (46)
66 (64)
24-hour BP control
†
[
n
(%)]
0
47 (46)
48 (47)
Clinic PP (mmHg)
69.5
±
17.1
56.7
±
15.3**
49.8
±
14.6**
24-hour PP (mmHg)
55.7
±
11.9
46.0
±
9.8**
46.3
±
8.7**
LV end-diastolic diameter (mm)
46.6
±
5.8
45.3
±
5.3*
45.2
±
5.1*
LV end-systolic diameter (mm)
30.1
±
5.6
29.0
±
5.0**
28.6
±
5.4**
LV septal wall thickness (mm)
12.5
±
2.1
11.4
±
1.9**
11.4
±
1.9**
LV posterior wall thickness (mm)
11.3
±
2.2
10.5
±
1.7**
10.4
±
1.8**
LV mean wall thickness (mm)
11.9
±
2.0
11.0
±
1.5**
10.9
±
1.5**
LV relative wall thickness (ratio)
0.50
±
0.11
0.47
±
0.10*
0.47
±
0.11*
LVM (g)
215
±
64
182
±
48**
179
±
43**
LVMI (g/m
2.7
)
63.7
±
19.0
53.7
±
13.9**
52.8
±
12.3**
LVH [
n
(%)]
73 (71)
48 (47)**
52 (50)**
LV relative wall thickness [
n
(%)]
65 (63)
55 (53)*
50 (49)**
LV, left ventricular; LVH, left ventricular hypertrophy; SBP, systolic blood pressure; DBP, diastolic BP; PP, pulse pressure; LVM, left ventricular
mass; LVMI, left ventricular mass index.
†
Percentage of clinic BP (
<
140/90 mmHg) and 24-hour BP control (
<
130/80 mmHg), *
p
<
0.05, **
p
<
0.01 versus baseline values.
