CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 3, April 2012
150
AFRICA
category after 13 months of treatment. Moreover, from 20 (19%)
patients initially with eccentric LVH, only six (30%) normalised
the LV structure, while four (20%) converted to concentric
remodelling, and nine (45%) remained with eccentric LVH.
From the 12 patients with concentric remodelling, six (50%)
normalised their LV structure and five changed to eccentric LVH.
Table 3 shows the characteristics after four and 13 months
of therapy of hypertensive patients, grouped according to
the mass and geometry of the left ventricle. At four months
of antihypertensive therapy, no significant differences were
observed in age, gender, BMI, any BP measurements, BP control
rates, or type of antihypertensive medication between patients
grouped according to LV geometric patterns (data not shown).
After 13 months of antihypertensive therapy no significant
differences were noted in age, gender, ambulatory or clinic
systolic or diastolic BP, clinic PP, BP control rates, or type of
antihypertensive medication between patients grouped according
to LV geometric patterns. However ambulatory and clinic PP
were higher in patients with concentric and eccentric LVH.
In multiple regression analysis with age, gender, 24-hour PP
and BMI included in the models, at 13 months, 24-hour (
p
=
0.02)
and day PP (
p
=
0.02) were independently related to an abnormal
residual LV structure after treatment (Table 4). Moreover, when
baseline LVM was added to the model, 24-h PP (
p
=
0.004) still
showed an independent association with residual LV structural
abnormalities. Clinic PP was not a significant predictor of
abnormal residual LV structural abnormalities after 13 months of
therapy (
p
=
0.09). Neither 24-hour systolic/diastolic nor clinic
systolic/diastolic BP control was independently associated with
residual LV structural abnormalities (data not shown).
Discussion
Themain findings of this study are that in hypertensives ofAfrican
ancestry, after more than a year of stepwise antihypertensive
therapy, which achieved clinic BP control in 64% of patients and
24-hour BP control in 47% of patients by 13 months of therapy,
Fig. 1. Changes in the prevalence of a normal left ventric-
ular (LV) structure, concentric LV hypertrophy (LVH),
concentric LV remodelling and eccentric LVH after four
and 13 months of antihypertensive therapy. *
p
<
0.05 ,**
p
<
0.01 compared to 0 months (baseline).
60
50
40
30
20
10
0
Prevalence (%)
Normal
Concentric
LVH
Concentric
remodelling
Eccentric
LVH
17.5
4 months
Baseline
13 months
27 26
26 25
25
26
51.5
12
23
20 19
TABLE 3. CHARACTERISTICS OF PATIENTSAFTER 13 MONTHS OFANTIHYPERTENSIVE THERAPY
GROUPEDACCORDINGTO LEFTVENTRICULAR STRUCTURE
Geometry
Normal
Concentric LVH Concentric remodelling
Eccentric LVH
Number (%)
27 (26)
26 (25)
24 (23)
26 (25)
BMI (kg/m
2
)
28.9
±
8.6
32.3
±
5.3**
31.8
±
5.0**
31.7
±
5.0**
Age (years)
48.9
±
10.1
52.3
±
10.0
52.8
±
8.0
51.8
±
10.0
Female gender [
n
(%)]
22 (81)
22 (85)
20 (83)
21 (81)
24-hour SBP/DBP (mmHg)
122
±
12/80
±
7
128
±
13/79
±
7
128
±
11/83
±
8
128
±
12/79
±
9
Clinic SBP/DBP (mmHg)
129
±
14/84
±
8
139
±
20/84
±
10
135
±
17/89
±
9
137
±
22/84
±
11
24-hour BP control [n (%)]
10 (37)
14 (54)
15 (58)
9 (38)
Clinic BP control [n (%)]
19 (70)
17 (64)
19 (73)
11 (46)
24-hour PP (mmHg)
42.1
±
8.3
49.1
±
9.9**
45.5
±
6.0
48.8
±
8.5**
Clinic PP (mmHg)
44.4
±
10.9
55.4
±
17.3**
45.8
±
12.2
53.3
±
14.8**
LVM (g)
146
±
21
208
±
33**
148
±
26
211
±
36**
LVMI (g/m
2.7
)
41.2
±
5.8
62.1
±
8.5**
43.7
±
5.5
63.7
±
6.9**
LV mean wall thickness (mm)
9.3
±
0.8
12.3
±
1.1*
11.1
±
1.0*
10.9
±
1.1*
LV relative wall thickness (ratio)
0.38
±
0.04
0.55
±
0.08**
0.57
±
0.07**
0.39
±
0.05
Concentric LVH at baseline [
n
(%)]
7 (26)
18 (69)**
13 (54)
15 (58)
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 compared to the normal group.
TABLE 4. PREDICTORS OFABNORMAL GEOMETRY
AFTER 13 MONTHS OF THERAPY
Odds
ratio
95% CI
odds ratio
p
-value
Logistic regression model with 24-hour PP
BMI (kg/m
2
)
1.087 0.985–1.198 0.096
Age (years)
1.032 0.979–1.088 0.245
Gender (female)
1.550 0.369–6.503 0.549
Baseline RWT (ratio)
0.874 0.528–1.448 0.601
24-hour PP (mmHg)
1.087 1.012–1.168 0.023
Logistic regression model with day PP
BMI (kg/m
2
)
1.094 0.993–1.205 0.071
Age (years)
1.030 0.977–1.086 0.269
Gender (female)
1.543 0.372–6.328 0.554
Baseline RWT (ratio)
0.875 0.527–1.453 0.606
Day PP (mmHg)
1.087 1.012– 1.168 0.023
BMI, body mass index; PP, pulse pressure; RWT, relative wall thickness.
** **
* *
