Perspective:

This large-scale longitudinal study, spanning serial blood pressure determination over a 24- to 28-year period, demonstrates the relationship between elevated blood pressure and subsequent development of LV hypertrophy. It should be emphasized that this study population was a relatively homogenous Caucasian population of British subjects, and the observations may not apply to other ethnic groups. The major finding of this study was that elevated blood pressure in midlife predicts the presence of elevated LVMI in later life and that this effect is not fully reduced by hypertensive therapy. Of note, the HTT was with a variety of agents, and whether a single specific agent would have resulted in a different effect is purely conjectural. Another major finding was the apparent age threshold for subsequent development of LV hypertrophy in which individuals with a faster increase in SBP between the ages of 43 and 53 were more likely to have a greater increase in LVMI. If one presumes that increased LVMI with attendant fibrosis is a long-term risk factor for cardiovascular events, this study raises an important issue regarding the timing and nature of treatment of hypertensive patients and supports the rationale for further prospective studies aimed at reversal of LV and myocardial fibrosis. Not addressed in this study was whether the elevated LVMI predisposed the study subjects to an increased risk of cardiovascular events including heart failure and myocardial infarction.