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Hypertension and the heart


This was a well attended session with 4 excellent lectures.
Giovanni de Simone (Napoli) stated that males & females had equal numbers of cardiac myocytes but males at puberty developed greater left ventricular hypertrophy (LVH). Concentric hypertrophy caused fibrosis. Knockout mice had preserved LV function despite no LVH. LV mass is linearly related to body size from mice to horses! The best relation for LVM was for fat free body mass, so body surface area (BSA) fails. Trials & clinic produce similar regression, although reduced by metabolic risk factors.
Frank Ruschitska (Zurich) emphasised the role of heart failure (HF) for morbidity & mortality - neglected compared with stroke or MI. Data by Tocci (J Hyp 2008) showed that HF caused twice as many deaths as all cancers combined. In 60-69 year old males, congestive HF (CHF) accounted for 20% of total mortality (Yusuf & Pitt, Circulation 2002). CHF is eminently treatable, but for hypertension, this needs to be early! New regression trials will report in the next year or two. Finally, he discussed choice of diuretic, stating that the best evidence favoured Indapamide or chlorthalidone, not low dose thiazides.
Tony Heagerty cited the importance of LVH in ischaemic heart disease & old versus newer drugs. The main factor was the resultant blood pressure, not the drugs used. He also discussed the J-curve, not very important for most hypertensives. New consensus favours a target below 140/90 mmHg.
Finally, Gregory Lip (Birmingham, UK) showed the importance of HT for atrial fibrillation – pointing out ethnic differences, where HT is much more a factor for Afro-Carribeans than Indo/Asians.




Hypertension and the heart

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.