1. ¹Istituto di Medicina Cardiovascolare, Università di Milano, Milano, Italy
2. ²Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, Italy
3. ³Clinica Medica e Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Applicate, Università di Milano Bicocca, Milano, Italy
4. ⁴Dipartimento di Medicina Clinica e Biotecnologia Applicata Università degli Studi di Bologna, Policlinico S.Orsola Malpighi, Bologna, Italy
5. ⁵Dipartimento di Medicina Sperimentale Università degli Studi di Padova, Padova, Italy
6. ⁶Clinica Medica, Università degli Studi di Napoli Federico II, Napoli, Italy
7. ⁷Istituto Auxologico Italiano, Milano, Italy

Correspondence: Dr C Cuspidi, Centro Interuniversitario di Fisiologia Clinica, Via F. Sforza 35, 20122 Milano, Italy. E-mail: dhipertensione@libero.it

Received 6 February 2004; Revised 6 June 2004; Accepted 6 June 2004; Published online 29 July 2004.

Abstract

The impact of hypertension on left ventricular (LV) and vascular structure and the relation of left ventricular hypertrophy (LVH) with vascular changes in untreated essential hypertensives has not been fully explored. This study investigated the prevalence of structural abnormalities of LV and carotid arteries and their determinants in a large population of untreated, uncomplicated essential hypertensive patients. The Assessment of Prognostic Risk Observational Survey was a multicentre (44 centres) prospective study including 1142 untreated hypertensives classified as low or medium cardiovascular risk on the basis of the routine diagnostic work-up recommended by the 1999 World Health Organization/International Society of Hypertension guidelines. All patients underwent ultrasound examinations of the heart and carotid arteries. LVH and carotid structural changes were diagnosed when: (1) LV mass index exceeded 125 g/m² in men and 110 g/m² in women; (2) there was at least one plaque (focal thickening>1.3 mm) in any segment of either carotid artery or a diffuse common carotid intima–media thickness (IMT) (average of IMT0.8 mm) was present. Overall, 1074 patients (504 women, mean age 48.111.4 years) completed the study with ultrasonographic examinations of good technical quality. The prevalences of LVH and LV concentric remodelling in the total population were 26.8 and 10.7%, respectively. Eccentric hypertrophy was more prevalent than concentric hypertrophy (15.2 vs 11.6%). One or more carotid plaques or thickening were present in 27.4% of the patients. A stepwise increase in IM thickness occurred from the lowest values in patients with normal cardiac mass and geometry (0.68 mm) to intermediate in those with LV remodelling (0.76 mm) and eccentric LVH (0.81 mm) and to the highest level in patients with concentric LVH (0.87 mm). Patients with LV concentric remodelling and concentric LVH had a significantly greater relative carotid wall thickness than those with normal geometry and eccentric LVH (0.25 and 0.26 vs 0.18 and 0.19, respectively, P<0.01). According to a multivariate analysis age, blood glucose, systolic BP and pulse pressure were the main independent predictors of LVH, while age, systolic BP and total cholesterol were the variables with the greatest impact on IM thickening. To conclude, this study shows that: (1) altered patterns of LV structure and geometry and carotid structural changes occur in a large fraction of patients with untreated essential hypertension; (2) there is a significant association between carotid wall thickening and LVH; (3) the probability of LVH or carotid thickening is significantly greater in elderly, in patients with higher systolic BP and in patients with associated metabolic risk factors.