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High-normal blood pressure and abnormal left ventricular geometric patterns

a meta-analysis

Cuspidi, Cesarea,b; Sala, Carlac; Tadic, Marijanad; Gherbesi, Elisac; Facchetti, Ritaa; Grassi, Guidoa,e; Mancia, Giuseppeb

doi: 10.1097/HJH.0000000000002063

Aim: The association between prehypertension (pre-HTN) and abnormal left ventricular (LV) geometric patterns is unclear. We performed a meta-analysis of echocardiographic studies aimed to provide a new piece of information on LV geometric alterations in untreated pre-HTN individuals.

Design: Studies were identified by crossing the following search terms: ‘prehypertension,’ ’high normal blood pressure,’ ‘heart,’ ‘LV hypertrophy’ (LVH), ‘LV geometry,’ ‘LV mass,’ and ‘echocardiography.’

Results: A total 60 949 participants (38 536 normotensive, 14 453 pre-HTN, and 7960 HTN individuals) were included in six studies. LV concentric remodelling was the most common abnormal pattern in pre-HTN participants followed by eccentric and concentric LVH. Compared with normotensive group, pre-HTN exhibited a higher risk of LV concentric remodelling (OR 1.89, CI 1.70–2.10, P < 0.001), eccentric LVH (OR 1.65, CI 1.40–1.90, P < 0.001) and concentric LVH (OR 2.09, CI 1.50–3.00, P < 0.001). The likelihood of having abnormal LV patterns in HTN was significantly higher (P < 0.001 for all) than in pre-HTN participants.

Conclusion: Our meta-analysis shows that alterations in LV geometry in pre-HTN individuals are intermediate between normotensive and HTN individuals. These findings suggest that pre-HTN is associated to early changes in LV structure and geometry, and preventive strategies may have a protective impact on development of subclinical cardiac damage in this setting.

aDepartment of Medicine and Surgery, University of Milano-Bicocca

bClinical Research Unit, Istituto Auxologico Italiano IRCCS

cDepartment of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milan, Italy

dDepartment of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany

eIstituto di Ricerche a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy

Correspondence to Professor Cesare Cuspidi, Clinical Research Unit, Istituto Auxologico Italiano IRCCS, Viale della Resistenza 23, 20036 Meda, Italy. Tel: +39 362 772433; fax: +39 362 772416; e-mail:

Abbreviations: BP, blood pressure; CI, confidence interval; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; OR, odd ratio; pre-HTN, prehypertension; RWT, relative wall thickness; SD, standard deviation; SE, standard error; SMD, standard means difference

Received 17 November, 2018

Revised 8 January, 2019

Accepted 11 January, 2019

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