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CardiologyDM Cardiology

Left Ventricular Hypertrophy as a Predictor of Major Adverse Cardiovascular Events in Resistant Hypertension: A 2-Year Follow-Up Study

Dr. Anil Kumar Joshi¹, Dr. Smita Wagle¹, Dr. P. Balakrishnan²

¹ Dept. of Cardiology, KEM Hospital, Mumbai · ² Dept. of Cardiology, Seth GS Medical College

P5

CSI Annual Conference 2025 — Cardiological Society of India

Background
  • Resistant hypertension (RH) — BP uncontrolled on ≥3 antihypertensives — affects 12–15% of Indian hypertensives
  • LVH is the most prevalent target organ damage in RH and a strong independent predictor of MACE
  • Echocardiographic LVH regression under treatment and its relationship with MACE outcomes is not studied in Indian RH cohorts
Objective

To assess the prevalence of LVH in resistant hypertension, correlate LV mass index with MACE events at 2-year follow-up, and determine LVH regression rate with optimised antihypertensive therapy.

Methods
Design:Prospective observational cohort study
Setting:Hypertension clinic, KEM Hospital, Mumbai
Period:January 2023 – December 2024 (2-year follow-up)
Sample:n = 96 (resistant hypertension patients) — calculated using MACE incidence 18%, α = 0.05, power 80%
Statistics:Kaplan-Meier survival curves, Cox proportional hazards model, Pearson correlation (R v4.3)
Key Findings
LVH PrevalenceECG confirmed

71% (68/96)

LVMI >115 g/m² men, >95 g/m² women

MACE at 2 yearsp = 0.004

LVH 29% vs No-LVH 11%

HR = 2.8 (95% CI 1.4–5.6)

LVH Regressionp < 0.001

58% showed regression

With spironolactone + ARNI

LVMI reductionr = 0.71, p < 0.001

−18.4 g/m² mean

Correlated with BP control

Results

LVH was present in 71% of resistant hypertensives. Patients with LVH had 2.8× higher 2-year MACE risk (HR 2.8, 95% CI 1.4–5.6, p = 0.004) vs those without LVH. Addition of spironolactone induced LVH regression in 58% with mean LVMI reduction of 18.4 g/m². LVMI regression strongly correlated with MACE-free survival (log-rank p < 0.0001).

Conclusion

LVH is highly prevalent (71%) in resistant hypertension and independently predicts 2.8× higher MACE risk. Spironolactone-induced LVH regression significantly reduces cardiovascular events. Routine echocardiography and aggressive LVH-targeted therapy should be standard in all resistant hypertension management.

Take-Home Message

Treat the LVH, not just the blood pressure — LVH regression cuts 2-year heart attacks and strokes by nearly 3-fold.

References
  1. 1. Jennings G et al. LVH regression reduces cardiovascular risk. Hypertension. 2021;78:1124
  2. 2. CSI Hypertension Guidelines 2024. Management of resistant hypertension in India. Indian Heart J. 2024;76(S1):S1

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Poster 5 of 5 · Cardiology