Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

from Journal of Clinical Hypertension

Lifestyle Modification Reduces Left Ventricular Hypertrophy

The presence of left ventricular hypertrophy (LVH) increases the risk for cardiac morbidity and mortality. Regression of LVH is associated with a reduction in risk. It has been demonstrated that LVH can be reduced when blood pressure is lowered by antihypertensive therapy; similar evidence for lifestyle interventions has been lacking.

To determine if aerobic exercise or weight management counseling in addition to exercise have a beneficial effect on left ventricular mass, investigators randomized 82 overweight or obese, sedentary adults (37 men, 45 women) with high-normal or grade or stage 1 elevated blood pressure hypertension (mean 140/93 mm Hg) to one of three groups: 1) a supervised aerobic exercise program; 2) a behavioral weight-loss program that included exercise; or 3) a control group. The three groups were comparable in all baseline clinical and demographic characteristics except that there were more nonwhites in the control group than the active treatment groups. No participants took antihypertensive therapy. Blood pressure and echocardiographic measures of left ventricular structure were measured at baseline and at the end of the 6-month study.

Compared to baseline, systolic blood pressure and diastolic blood pressure fell by 3/4 mm Hg in the exercise only group and 7/6 mm Hg in the weight management-exercise group, respectively. These reductions in blood pressure were associated with favorable decreases in left ventricular relative wall thickness, as well as posterior and septal wall thickness. There was a trend toward a reduction in left ventricular mass, independent of sex or race.

Nonpharmacologic measures such as aerobic exercise and weight loss not only reduce blood pressure but also induce favorable changes in left ventricular structure in overweight, sedentary patients with high-normal or mildly elevated blood pressure. There were no significant changes in the control group. — Hinderliter A, Sherwood A, Gullette E, et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med. 2002;162:1333-1339.Comment

Lifestyle interventions, including weight loss and aerobic exercise continue to be recommended as initial therapy in patients with uncomplicated high-normal or stage 1 elevated blood pressure. While a number of studies have shown these interventions to lower blood pressure, evidence that they reduce end-organ damage or prevent cardiovascular events has been lacking. This is the first study, small as it is, in a group of overweight, sedentary men and women that demonstrates that these nonpharmacologic measures lead not only to reductions in blood pressure but also result in echocardiographically measured beneficial changes in left ventricular structure. Whether these changes can be sustained over a longer time period remains to be determined.

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