Hypertension

• Patient assessment- brief overview

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• Guidelines
• New Zealand Guidelines: Threshold for Pharmacologic Treatment
• New Zealand Guidelines: Emerging Risk Factors
• Selected Information From JNC 7

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• Left Ventricular Hypertrophy
• LVH on ECG and prognosis
• LVH with echo and prognosis
• Africans have more LVH
• LVH- more information

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• Hypertension Trials
• Beta-blockers no longer first or second line agents for treatment of hypertension for all patients.
• Review of Hypertension trials- 2005
• ASCOT, LIFE, ALLHAT, ANBP2

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• Ambulatory and Home BP Monitoring
• Introduction

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• Lifestyle Measures
• Impact on Hypertension

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• Resistant Hypertension
• Meet the experts session- ESC 2008

Hypertension and Left Ventricular Hypertrophy

Asssessed with Echocardiography

Impact on Prognosis

One study which mainly enrolled African-Americans (J Am Coll Cardiol 1998;31:1635-40) showed that concentric LV remodelling increased risk of death only slightly, but those with eccentric LVH had a two fold increased risk and those with concentric LVH had a three fold increased risk of death.

The Framingham Heart Study also has shown increased risk of death in the presence of left ventricular hypertrophy by echo criteria independent of other factors (N Eng J Med 1990;322:1561-66). Those with greater degrees of left ventricular hypertrophy (indexed to height) had the highest risk for cardiac events, for cardiac death and for overall mortality. This increased risk was present even after adjustment for conventional risk factors, age and ECG evidence for left ventricular hypertrophy.

Obese patients are more likely to have LVH but it is not certain that they are at the same risk as non-obese patients with the same LV mass (J Am Coll Cardiol 1997;29:641-7). This suggests, for the purposes of risk stratification, LV mass may be better adjusted for body surface area (or possibly to height^2.7) rather than to height.