Effect of treatment of isolated systolic hypertension on left ventricular mass

Context.-Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known, Objective.-To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH, Design.-Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP), Patients.-A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms, Intervention.-The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure, Main Outcome Measure.-Change in LV mass assessed by echocardiography, Results.-Minimum follow-up was 3 years, In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively, The LV mass index was 93 g/m(2) in the active treatment group and 100 g/m(2) in the placebo group (P<.001), The LV mass index declined by 13% (95% confidence interval, -3% to -23%) in the active treatment group compared with a 6% increase (95% confidence interval, -3% to + 16%) in the placebo group over 3 years (P=.01). Conclusion.-Treatment of ISH with a diuretic-based regimen reduces LV mass.