HIGH NORMAL BLOOD PRESSURE AND ABNORMAL LEFT VENTRICULAR GEOMETRIC PATTERNS

Objective: The association between pre-hypertension (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 subjects. Design and method: Studies were identified by crossing the following search terms: “pre-hypertension”,“high normal blood pressure”, “heart”, “LV hypertrophy” (LVH), ‘LV geometry’, “LV mass”, echocardiography. Results: A total 60,949 subjects (38,536 normotensive, 14,453 pre-HTN, and 7,960 HTN individuals) were included in 6 studies. LV concentric remodelling was the most common abnormal pattern in pre-HTN subjects followed by eccentric and concentric LVH. Compared to 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.Conclusions: Our meta-analysis shows that alterations in LV geometry in pre-HTN subjects 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.