Abstract 9358: Time-Course of Left Ventricular Geometry in Arterial Hypertension: The Strong Heart Study

Background: The natural history of hypertensive heart disease is postulated to evolve from concentric LV geometry (LVG) to eccentric and eventually dilated LVG. However, there is no evidence of this evolution, likely due to effect of antihypertensive therapy, and there is no information on whether changes of LVG can be predictable. Methods: We examined echocardiograms in 850 hypertensive participants of the 4th phase of the Strong Heart Study (SHS) cohort (50±14 yrs, 486 women), who repeated echo exam after 4 years. LVG was assessed by relative wall thickness. Results: LVG remained normal (NN) in 55% of men (M) and 45% of women (W), remained concentric (CC) in 19% M and 30% W, changed from concentric to normal (CN) in 22% M and 19% W, and from normal to concentric (NC) in 4% M and 6% W (p<0.001). Between exams, acute myocardial infarction occurred in 4 participants (0.5%). Participants with concentric LVG at the second exam (NC and CC) were older than the other groups (p<0.001). At the time of initial exam, systolic blood pressure (BP) was slightly higher in participants developing concentric LVG (NC p=0.056), whereas diastolic BP and GFR were lower in those with persistent concentric LVG than in the other groups (both p<0.001). Initial LV mass was higher and ejection fraction (EF) lower in CN and CC than in NN (p<0.0001). Compared to NN, systolic BP increased over time in participants with concentric LVG at the second exam (NC and CC; both p<0.03). On average, EF decreased over time, with the greatest decrease in participants changing LVG from concentric to normal and the minimum decrease in those developing concentric LVG (all p<0.001). No effect of body size, fat distribution and prescription of classes of antihypertensive meds and statins could be detected, but the number of antihypertensive meds used at the time of the initial exam was significantly higher with persistent concentric LVG and lower with evolution from concentric to normal LVG (p<0.001). Conclusions: Changes in LV geometry in treated SHS hypertensive participants are not related to type of antihypertensive meds. Persistent concentric LV geometry is related to older age, and increasing systolic BP over time despite greater intensity of anti-hypertensive therapy.