MANAGEMENT OF ESSENTIAL-HYPERTENSION IN PATIENTS WITH DIFFERENT DEGREES OF LEFT-VENTRICULAR HYPERTROPHY - MULTICENTER TRIAL

Three hundred and four hypertensive patients with different degrees of left ventricular hypertrophy (LVH) were recruited and followed for 4 years. The patients were randomized into two groups: Group I (150 patients) was treated with a combination of hypotensive drugs including beta-blockers, and group II (154 patients) was treated with the same combination of drugs including diuretics instead of beta-blockers. By the end of the fourth year, 60 endpoints were recorded: 17 strokes, 13 myocardial infarctions, and 30 cases of chronic coronary insufficiency. Mortality was statistically higher in group II (7 of 154 or 5% v 1 of 150 or 1%) (P < .035), but there was no difference between the groups in the incidence of nonfatal endpoints. These data confirm that beta-blockers can reduce mortality associated with the complications presented in hypertensive patients. Increased left ventricular myocardial mass (> 200 g, according to Teichholz' formula) was shown to have prognostic value for the development of complications. In patients with LVMM > 200 g, the probability of fatal complications was higher (P < .007), as was the probability of nonfatal myocardial infarction (P < .01), development of coronary artery disease (P < .02), and all complications (P < .0003). Regression of LVH to < 200 g (according to Teichholz' formula) improved prognosis.