Should Physicians Aggressively Treat Prehypertension?
Article Outline
To the Editor:
In their investigation aimed at determining the degree to which left ventricular hypertrophy predicts mortality in different ethnic/racial groups, Havranek et al sought to identify the prevalence of left ventricular hypertrophy among these groups.1 Using electrocardiogram criteria, the National Health and Nutrition Examination Survey III, and the National Death Index, the investigators were able to analyze a large sample (7495 study subjects) to achieve their goal.
Previous studies have indicated higher risk of mortality for African-American patients with left ventricular hypertrophy.2 The current study confirmed these results. In addition, Latino-Americans also had nearly double the risk of cardiovascular mortality as white study subjects. Moreover, African-American participants had nearly 3 times the risk of 5-year cardiovascular mortality as white participants.
Although adjusted hazard ratios for 5-year cardiovascular mortality for African-American subjects where nearly 3 times that of white participants, and those of Latinos were almost twice that of white subjects, the authors emphasized that the 5- and 10-year total mortality was “muted.”
However, while hazard ratios for total mortality were not significantly different among the 3 groups, the nearly 3-fold risk increase in 5-year cardiovascular mortality for African-Americans must be underscored. Given the specific aim of the study, these results suggest that clinicians who successfully and aggressively treat hypertension, thereby alleviating the key etiology causing left ventricular hypertrophy, would achieve a significant reduction in cardiovascular death for their African-American patients, along with patients from other ethnic groups.
This current investigation by Havranek et al also raises some interesting queries about echocardiograph assessment for patients with early-stage hypertension. When should clinicians evaluate such patients for possible left ventricular hypertrophy, given that many of these patients have possibly been prehypertensive for years? Should such an evaluation commence on diagnosis of prehypertension? Would such aggressive intervention further decrease the short- and long-term cardiovascular mortality and possibly positively impact total mortality? Given the prevalence of hypertension in African-Americans in particular and in Americans in general, such uncertainties are critical to resolve.
References
Funding Source: Morehouse School of Medicine, Atlanta, Georgia.
Conflict of Interest: None.
Authorship: The author had access to all data and wrote this manuscript.
PII: S0002-9343(09)00054-0
doi:10.1016/j.amjmed.2008.11.029
© 2009 Elsevier Inc. All rights reserved.
