Content area
Full Text
Figure 1. Left ventricular geometric patterns in hypertensive patients. Echocardiography demonstrates four different patterns of adapting to hypertension in relation to LVMI or RWT, calculated as two-times posterior wall thickness/left ventricular internal diameter in diastole. Concentric remodeling = increased RWT but normal left ventricular mass. LVMI: Left ventricular mass index; RWT: Relative wall thickness. Adapted from [40].
(Figure omitted. See article PDF.)
Hypertension is an important precursor for development of cerebrovascular disease, ischemic heart disease, renal and cardiac failure. Globally, hypertension is estimated to cause 7.1 million premature deaths, including 62% of cerebrovascular disease, and 49% of ischemic heart disease is attributable to suboptimal blood pressure control [1]. Indeed, a meta-analysis of 61 prospective observational studies showed that each 20 mmHg rise in systolic blood pressure (and 10 mmHg rise in diastolic blood pressure) is associated with a twofold increase in mortality from coronary disease and stroke [2].
Hypertension also contributes to the development of congestive heart failure (CHF) - with the highest population-attributable risk among all risk factors for CHF - by conferring a twofold increased risk among men and threefold risk among women (Table 1) [3,4]. Although the risk of developing CHF is a complex multifactorial process that involves risk factors such as obesity, diabetes, smoking and dyslipidemia, hypertension still remains one of the most important risk factors [5]. The Framingham Study estimated that the lifetime risk of developing CHF at 40 years of age was 21% for men and 20% for women, but in the absence of documented myocardial infarction, the risk for a 40-year old was 11% for men and 15% for women [6]. Of note, hypertension, either alone or in combination with cardiovascular disease, preceded the development of heart failure in 70% of both men and women [7], and accounted for 40% of deaths [8]. In recent years, antihypertensive treatment has significantly reduced the risk of CHF. Major studies in the elderly population, such as the Systolic Hypertension in the Elderly Program (SHEP) and the Swedish Trial in Old Patients with Hypertension (STOP), found that antihypertensive therapy reduced the risk of CHF by 35-54% [9-12]. Even with the best modern therapy available, CHF is still associated with an average annual mortality of 10% [13].
Stroke is still one of...