Abstract

Objective: Left ventricular hypertrophy (LVH) confers high cardiovascular risk. Regression of LVH reduces risk. Patients with blood pressure in the normal range and LVH are common. We investigated whether further reduction in blood pressure would further regress LVH.

Methods: Fifty-one subjects with blood pressure in the normal range and echocardiographic left ventricular hypertrophy were randomly assigned to active treatment (antihypertensive medication), or placebo in a ratio of 2:1. The aim was to maintain office systolic blood pressure at 10mmHg less than baseline in the active arm and at baseline level in the placebo arm. Cardiac magnetic resonance imaging was used to measure change in left ventricular mass index over 12 months.

Results: Thirty-five subjects completed the study (active 23 : placebo 12). Average baseline office systolic blood pressure was [mean±standard deviation] 122(±9)mmHg in the active group and 124(±9)mmHg in the placebo group (p = 0.646). The mean baseline left ventricular mass index was 65.88(±11.87)g/m2 in the active group and 59.16(±11.13)g/m2 in the placebo group (p = 0.114). The mean difference between baseline and end of study office systolic blood pressure was –9.33(±8.56)mmHg in the active group and –0.08(±9.27)mmHg in the placebo group (p = 0.007). The mean change in left ventricular mass index was –4.68(±7.31)g/m2 in the active group and +1.97(±6.68)g/m2 in the placebo group (p = 0.014).

Conclusions: Reduction in office systolic blood pressure, already in the normal range, of approximately 9mmHg, leads to a reduction in left ventricular mass. Further work is required to see if this also leads to a reduction in cardiovascular events.