FACTA UNIVERSITATIS

Vol. 9, No 2, 2002 pp. 181 - 187
UC 656.073.851:616.12-008.331.1

RELATIONSHIP BETWEEN OBESITY DECREASE AND REGRESSION
OF HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY
Ivan S. Tasić¹, Branko K. Lović¹, Stevan Ilić¹, Dragan Djordjević¹, Nataša Miladinović Tasić²
¹Institute of Cardiology and Rheumatology "Niska Banja", Niska Banja, Yugoslavia
²Institute of Health Protection, Niš, Yugoslavia
E-mail: doradika@eunet.yu

Summary. There is a well-known relationship between obesity and hypertensive left ventricular hypertrophy. However, little is known about the relationship between obesity decrease and regression of hypertensive left ventricular hypertrophy.
The aim of the study is assessment of relationship between obesity decrease and regression of hypertensive left ventricular hypertrophy.
73 patients with II-III stage hypertension (43 male), average age 55.9 ą 8 and LVH determined by echocardiography (average left ventricular mass (LVM) index: 164 ? 32 g/m2; Penn convention) have been treated (by medication and by diet) for a year. Each subject underwent two-dimensional and Doppler echocardiography, 12-lead electrocardiogram examination (QTc interval dispersion), exercise stress testing (Bruce - protocol), 24-h ambulatory monitoring blood pressure (ABPM), 24-h Holter monitoring with Lown classification of ventricular arrhythmia's and heart rate variability. Mean body mass index (BMI) was 28.7 ą 3.6 kg/m? (23 to 39), and 28 (39%) patients were obese (BMI > 30 kg/m?) (OH group).
After one year systolic BP (SBP) was reduced on the average been 168 +/- 26 to 158.2 ? 21 mmHg, diastolic BP (DBP) from 102 +/- 12.7 to 97 +/- 11 mmHg. LV mass index was reduced from 163 +/- 32 to 150.2 +/- 27 g/m2 (all p<0.001). 22 patents (30.1%) lost weight more than 5%. These patients significantly decreased LV mass 309 +/- 79 vs 278.4 +/- 61 g; t=3.22 p<0.004), LV mass index (161 +/- 35 vs 148 +/- 29 kg/m?; t=2.68; p<0.02), LV diastolic dimension (52.3 +/- 4.7 vs 50.5 +/- 4.4 mm; t=2.95, p<0.008), Cornell's index (1.55 +/- 0.4 vs 1.41 +/- 0.4, p<0.02), peak double product (DP) (27.3 +/- 5 vs 24.4 +/- 5, t=2.8, p<0.02), DP/METTs (2.48 +/- 1 vs 1.84 +/- 1, t=2,15; p< 0.05), mean 24h systolic BP (SBP) (144.1 +/- 17 vs 138.6 +/- 16 mmHg, t=2.2 p<0.04), mean 24h diastolic BP (DBP) (89.5 +/- 11 vs 85.7 +/- 12 mmHg, t = 2.2, p<0.04), mean SBP per day (148.2 +/- 18 vs 141 +/- 16 mmHg, t=2.6, p<0.02), mean DBP per day (92.7 +/- 11 vs 88 +/- 13 mmHg, t=2.6, p < 0.02) and increase of mean 24h RR intervals per night (938.2 vs 999 ms; t= 3, p<0,007).
Patients (51.70%) who didn't achieve significant loss of weight significantly decreased LV mass index (163 +/- 30 vs 152 +/- 25 kg/m?; t=2.1; p<0.05), office SBP (170.3 +/- 27 vs 158.9 +/- 19, t=2.2, p<0.03), grades of ventricular arrhythmias (2.73 vs 1.95, t=2.1, p<0.04), and mean VES/24h (66.6 vs 20, t=2.22, p<0.04).
Hypertensive patients with LVH with significant loss of weight after one year, achieved higher grade of LVH regression (on account of decrease of LV diastolic dimension), lower DP at exercise, lower values of BP during 24-hour monitoring and improvement of heart rate variability, than patients without significant loss of weight.
Key words: Obese, hypertension, left ventricular hypertrophy, regression

ODNOS IZMEĐU SMANJENJA GOJAZNOSTI I REGRESIJE
HIPERTENZIVNE HIPERTROFIJE LEVE KOMORE Kratak sadržaj: Dobro je poznat odnos između gojaznosti i hipertenzivne hipertrofije leve komore (HLK). Međutim manje je poznat odnos između smanjenja stepena gojaznosti i regresije hipertenzivne HLK
Cilj ove studije bio je da utvrdi vezu između smanjenja gojaznosti i regresije HLK.
73 bolesnika sa hipertenzijom II-III stepena (43 muškaraca), prosečne starosti 55.9 ą 8 i sa ehokardiografski utvrđenom HLK (prosečni indeks mase leve komore 164 ą 32 g/m?, Penn konvencija) lečeno je (medikamentima I dijetom) godinu dana. Svakom ispitaniku rađen je Dopler ehokardiografija, 12 kanalni EKG (QTc disperzija), test fizičkim opterećenjem (Brusov protokol), 24h ambulatorni monitoring KP, 24h Holter monitoring sa Lownovom klasifikacijom ventrikularnih aritmija i varijabilnost srčane frekvence. Prosečni indeks mase tela iznosio je 28.7 +/- 3.6 kg/m? (23-29), a 28 (39%) je bilo gojazno (IMT > 30 kg/m?)
Posle jednogodišnjeg tretmana sistolni KP (SKP) snižen je sa 168 +/- 26 na 158.2 +/- 21 mmHg, sijastolni KP (DKP) sa 102 +/- 12.7 na 97 +/- 11 mmHg. Indeks MLK smanjen je sa 163 +/- 32 na 150.2 +/- 27 g/m? (sve p<0.001).
22 (30.1%) bolesnika je smanjilo težinu za više od 5%. Ovi bolesnici značajno su smanjili MLK sa 309 +/- 79 na 278 +/- 61 g; t=3.22, p<0.004. indeks MLK (161 +/- 35 prema 148 +/- 29; kg/m?, t=2.68, p<0.02), dijastolni dijametar LK (52.3 +/- 4.7 prema 50.5 +/- 4.4 mm; t=2.95, p<0.008), Cornell-ov indeks (1.55 +/- 0.4 prema 1.41 +/- 0.4; p<0.02), maksimalni dvostruki proizvod (DP) (27.3 +/- 5 prema 24.4 +/- 5; t=2.8, p<0.02), odnos DP/METTa (2.48 +/- 1 prema 1.84 +/- 1; t=2.15; p<0.05), srednji 24h SKP (144.1 +/- 17 prema 138.6 +/- 16 mmHg; t=2.2, p<0.04), prosečni 24h DKP (89.5 +/- 11 prema 85.7 +/- 12 mmHg; t=2.2, p<0.04), srednji dnevni SKP (148.2 +/- prema 141 +/- 16 mmHg; t=2.6, p<0.02), srednji dnevni DKP (92.7 +/- 11 prema 88 +/- 13 mmHg; t=2.6, p<0.02) i povećali srednji 24h RR interval u toku noći (938.2 prema 999 ms; t=3, p<0.007). Pacijenti (51.7%) koji nisu značajno smanjili težinu takođe su značajno smanjili indeks MLK (163 +/- 30 prema 152 +/- 25 kg/m?, t=2.1; p<0.05), ambulantni SKP (170.3 +/- 27 prema 158.9 +/- 19, t=2.2, p<0.03), stepen ventrikularnih aritmija (2.73 prema 1.93, t=2.1, p<0.04), i srednji VES/24h (66.6 prema 20, t=2.22, p<0.04).
Hipertenzivni bolesnici sa HLK i sa značajnim smanjenjem težine posle jedne godine, postigli su veći stepen regresije HLK (prevashodno na račun smanjenja dijastolnog dijametra LK), manji DP na opterećenju, manji KP u toku 24h monitoringa i poboljšali varijabilnost srčane frekvence, nego bolesnici bez značajnog smanjenja težine.
Ključne reči: Gojaznost, hipertenzija, hipertrofija leve komore, regresija