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Can the Intensive Blood Pressure Control in Diabetes Reduce Left Ventricular Hypertrophy ? | OMICS International
ISSN: 2167-1095
Journal of Hypertension: Open Access
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Can the Intensive Blood Pressure Control in Diabetes Reduce Left Ventricular Hypertrophy ?

Leonardo Roever*

Federal University of Uberlândia, Department of Clinical Research, Brazil

*Corresponding Author:
Dr. Leonardo Roever
MHS, Department of Clinical Research
Av. Pará, 1720 - Bairro Umuarama.
Uberlândia - MG - CEP 38400-902 Brazil
Tel: +553488039878
E-mail: [email protected]

Received Date: October 26, 2015 Accepted Date: October 30, 2015 Published Date: November 06, 2015

Citation: Roever L (2015) Can the Intensive Blood Pressure Control in Diabetes Reduce Left Ventricular Hypertrophy ? J Hypertens 5:e114. doi:10.4172/2167-1095.1000e114

Copyright: © 2015 Roever L. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Left ventricular hypertrophy (LVH) is a common complication of hypertension and has been associated with higher risk for targetorgan damage. Insulin resistance and type 2 diabetes mellitus (DM), myocardial infarction(MI), cardiomyopathy, coronary artery disease( CAD) is reported to be associated LVH [1-4].

LVH is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic and systolic heart failure, and sudden death in patients with hypertension [5-7]. Echocardiographic assessment of LVH has a high specificity and sensitivity (≥ 80%). The presence of LV hypertrophy is often considered when LV mass >116 g/m2 for men (M) and >104 g/m2 for women (W), or >125 g/m2 for M and W [7]. Factors promoting left ventricular hypertrophy are presented in Table 1.

LVH is a manifestation of preclinical cardiovascular disease, strongly predicts MI, stroke, and cardiovascular death in patients with hypertension or CAD [8,9]. In the Framingham Heart Study, electrocardiographic (ECG) evidence of LVH was associated with a twofold increase in mortality over that resulting from hypertension alone [10].

Soliman et al. [11] examined the effect of intensive (systolic BP<120 mm Hg), compared with standard (systolic BP<140 mm Hg), BP lowering on the risk of LVH in 4331 patients with diabetes mellitus. The outcome measures were electrocardiographic LVH defined by Cornell voltage (binary variable) and mean Cornell index (continuous variable). The prevalence of LVH (5.3% versus 5.4%; P=0.91) and the mean Cornell index (1456 versus 1470 μV; P=0.45) were similar in the intensive (n=2154) and standard (n=2177) BP-lowering. After median follow-up of 4.4 years, intensive, compared with standard, BP lowering was associated with a 39% lower risk of LVH (odds ratio (95% CI), 0.61(0.43, 0.88); P=0.008) and a significantly lower adjusted mean Cornell index (1352 versus 1447 μV; P<0.001). The lower risk of LVH is associated with more regression of baseline LVH and lower rate of developing new LVH, compared with standard BP lowering. No interactions by age, sex, or race were observed.

This study provide evidence that a systolic BP of <120 mm Hg when compared with <140 mm Hg in patients with hypertension and DM produces a greater reduction in LVH.

References

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  8. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH (1991) Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension.Ann Intern Med 114: 345-352.
  9. Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, et al. (1992) The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease.Ann Intern Med 117: 831-836.
  10. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.N Engl J Med 322: 1561-1566.
  11. Soliman ES,Byington RP,Bigger JT,Evans G, Okin PM, et al. (2015) Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Diabetes Mellitus: Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial. Hypertension 115: 06236
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