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Relation of Left Ventricular Mass and Geometry to Morbidity and Mortality in Uncomplicated Essential Hypertension

Michael J. Koren, MD; Richard B. Devereux, MD; Paul N. Casale, MD; Daniel D. Savage, MD, PhD; and John H. Laragh, MD
[+] Article, Author, and Disclosure Information

Presented in part at the 39th Scientific Session of the American College of Cardiology, 20 March 1990, and at the 62nd Scientific Session of the American Heart Association, 15 November 1989.

Grant Support: In part by grant HL 18323 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

Requests for Reprints: Richard B. Devereux, MD, Division of Cardiology, Box 222, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021.

Current Author Addresses: Drs. Koren, Devereux, and Laragh: Department of Medicine, The New York Hospital-Cornell Medical Center, New York, NY 10021.

Dr. Casale: Department of Cardiology, Cleveland Clinic, Cleveland, OH 44195.

From The New York Hospital-Cornell Medical Center, New York, New York. For current author addresses, see end of text.†Dr. Savage died in January 1990.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(5):345-352. doi:10.7326/0003-4819-114-5-345
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Objective: To assess the prognostic significance of left ventricular mass and geometry in initially healthy persons with essential hypertension.

Design: An observational study of a prospectively identified cohort.

Setting: University medical center.

Patients: Two hundred and eighty patients with essential hypertension and no pre-existing cardiac disease were evaluated using echocardiography between 1976 and 1981. Two hundred and fifty-three subjects or their family members (90%) were contacted for a follow-up interview an average of 10.2 years after the initial echocardiogram was obtained; the survival status of 27 patients lost to follow-up was ascertained using National Death Index data.

Measurements and Main Results: Left ventricular mass exceeded 125 g/m2 in 69 of 253 patients (27%). Cardiovascular events occurred in a higher proportion of patients with than without left ventricular hypertrophy (26% compared with 12%; P = 0.006). Patients with increased ventricular mass were also at higher risk for cardiovascular death (14% compared with 0.5%; P < 0.001) and all-cause mortality (16% compared with 2%; P = 0.001). Electro-cardiographic left ventricular hypertrophy did not predict risk. Patients with normal left ventricular geometry had the fewest adverse outcomes (no cardiac deaths; morbid events in 11%), and those with concentric hypertrophy had the most (death in 21%; morbid events in 31%). In a multivariate analysis, only age and left ventricular mass—but not gender, blood pressure, or serum cholesterol level—independently predicted all three outcome measures.

Conclusions: Echocardiographically determined left ventricular mass and geometry stratify risk in patients with essential hypertension independently of and more strongly than blood pressure or other potentially reversible risk factors and may help to stratify the need for intensive treatment.





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