Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2009;62:246-54 - Vol. 62 Num.03 DOI: 10.1016/S1885-5857(09)71553-1

Cardiovascular Morbidity and Mortality and Left Ventricular Geometric Patterns in Hypertensive Patients Treated in Primary Care

Francisco J Tovillas-Morán a, Edurne Zabaleta-del-Olmo b, Antoni Dalfó-Baqué c, Miguel Vilaplana-Cosculluela d, Josep M Galcerán e, Antonio Coca f

a Equipo de Atención Primaria Martí i Julià, Cornellà, Barcelona, Spain. Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol, Barcelona, Spain. Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol, Barcelona, Spain
b Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol, Barcelona, Spain
c Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol, Barcelona, Spain. Equipo de Atención Primaria Gòtic, Barcelona, Spain
d Equipo de Atención Primaria Gòtic, Barcelona, Spain
e Fundació ALTHAIA, Manresa, Barcelona, Spain
f Unidad de Hipertensión, Instituto de Medicina y Dermatología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain

Keywords

Hypertension. Left ventricular hypertrophy. Ventricular remodeling. Cardiovascular disease. Primary care. Survival analysis.

Abstract

Introduction and objectives. Numerous hospital studies have shown that different left ventricular (LV) geometric patterns have different effects on cardiovascular risk. The aims of this study were to estimate the risk of major adverse cardiovascular events (MACEs) in hypertensive patients seen in primary care and to identify any association with LV geometric pattern. Methods. In total, 265 hypertensive subjects attending primary care were randomly selected and followed up for 12 years. Those with cardiovascular disease, secondary hypertension, complete bundle branch block or electrocardiographic signs of ischemic heart disease were excluded. The LV geometric pattern was characterized as either concentric hypertrophy, eccentric hypertrophy, concentric remodeling or normal. A MACE was the occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death. Data were analyzed using the life-table method and Cox regression modeling. Results. Although 14% of patients were lost to follow-up, their baseline characteristics were similar to those of patients who completed the study. The cumulative survival rate was 56.3% (95% confidence interval [CI], 49.8%-62.8%). The incidence of MACEs was 4.67 (95% CI, 3.79-5.55) per 100 subject-years. Moreover, the incidence was similar in the four LV geometric pattern groups (P=.889). Only age (hazard ratio [HR]=1.03; 95% CI, 1-1.05) and the presence of diabetes at study entry (HR=1.67; 95% CI, 1.03-2.69) were associated with an increased risk of a MACE. Conclusions. In the study population, only age and diabetes at study entry were associated with the occurrence of a MACE. There was no evidence for an association between MACEs and the LV geometric pattern.

1885-5857/© 2009 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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