Clustered metabolic abnormalities blunt regression of hypertensive left ventricular hypertrophy: the LIFE study

de Simone, G.; Okin, P.M.; Gerdts, E.; Olsen, M.H.; Wachtell, K.; Hille, D.A.; Dahlöf, B.; Kjeldsen, S.E.; Devereux, R.B.

doi:10.1016/j.numecd.2008.12.012

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 19, Issue 9 , Pages 634-640, November 2009

Clustered metabolic abnormalities blunt regression of hypertensive left ventricular hypertrophy: the LIFE study

G. de Simone
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
- Corresponding author. Department of Clinical and Experimental Medicine, Federico II University of Naples, via S. Pansini n. 5, 80131 Naples, Italy. Tel.: +39 081 746 2013; fax: +39 081 546 6152.
P.M. Okin
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
E. Gerdts
- Institute of Medicine, University of Bergen, and Haukeland University Hospital, Bergen, Norway
M.H. Olsen
- Department of Medicine, Glostrup University Hospital, Glostrup, Denmark
K. Wachtell
- Department of Medicine, Glostrup University Hospital, Glostrup, Denmark
D.A. Hille
- Merck Research Laboratories, Blue Bell, PA, USA
B. Dahlöf
- Sahlgrenska University Hospital, Östra, Göteborg, Sweden
S.E. Kjeldsen
- Ullevål University Hospital, Oslo, Norway
R.B. Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA

Received 15 October 2008; received in revised form 30 November 2008; accepted 18 December 2008. published online 13 April 2009.

Abstract

Background and aims

Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome predicted outcome in the LIFE study, independently of single risk markers, including obesity, diabetes and baseline ECG left ventricular hypertrophy (LVH). We examined whether clusters of two or more metabolic abnormalities (MetAb, including obesity, high plasma glucose without diabetes, low HDL-cholesterol) in addition to hypertension were associated to levels of ECG LVH reduction comparable to that obtained in hypertensive subjects without or with only one additional metabolic abnormality (no-MetAb).

Methods and results

We studied 5558 non-diabetic participants without MetAb (2920 women) and 1235 with MetAb (751 women) from the LIFE-study cohort. MetAb was defined by reported LIFE criteria, using partition values from the ATPIII recommendations. Time-trends of Cornell voltage–duration product (CP) over 5 years was assessed using a quadratic polynomial contrast, adjusting for age, sex, prevalent cardiovascular disease and treatment arm (losartan or atenolol). At baseline, despite similar blood pressures, CP was greater in the presence than in the absence of MetAb (p<0.0001). During follow-up, despite similar reduction of blood pressure, CP decreased less in patients with than in those without MetAb, even after adjustment for the respective baseline values (both p<0.002). Losartan was more effective than atenolol in reducing CP independently of MetAb.

Conclusions

Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome are related to greater initial ECG LVH in hypertensive patients with value of blood pressure similar to individuals without metabolic abnormalities, and are associated with less reduction of ECG LVH during antihypertensive therapy, potentially contributing to the reported adverse prognosis of metabolic syndrome.

Keywords: Hypertension, Obesity, Diabetes, Plasma cholesterol, Electrocardiography, Echocardiography