Skip to main content
SpringerLink
Log in

Obesity and Left Ventricular Hypertrophy: The Hypertension Connection

  • Hypertension and Obesity (E Reisin, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The detection of left ventricular hypertrophy (LVH) is recommended for risk prediction, and changes in LV geometry may provide further prognostic information. Obesity is a major determinant of LVH, but the approach to LVH detection in obese hypertensives remains a challenge. In the present review, we discuss evidence leading to the recent acceptance of the use of LV mass indexed to height2.7 or height1.7 rather than body surface area, for LVH detection and its regression in obesity. We also review recent findings which indicate that obesity-induced LVH may be associated with concentric LV remodeling, and hence, that the presence of concentric LVH in obesity should not be assumed to indicate a cause of LVH other than obesity. We also discuss recent evidence for obesity and blood pressure producing additive and interactive effects on LV mass, and hence, that weight loss and blood pressure reduction are required to achieve appropriate regression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141:334–41.

    Article  CAS  PubMed  Google Scholar 

  2. Verdecchia P, Angeli F, Borgioni C, et al. Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis. Am J Hypertens. 2003;16:895–9.

    Article  PubMed  Google Scholar 

  3. Gerdts E, Cramariuc D, de Simone G, et al. Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study). Eur J Echocardiogr. 2008;9:809–15.

    Article  PubMed  Google Scholar 

  4. Krumholz HM, Larson M, Levy D. Prognosis of left ventricular geometric patterns in the Framingham Heart Study. J Am Coll Cardiol. 1995;25:879–84.

    Article  CAS  PubMed  Google Scholar 

  5. Mancia G, Fagard R, Narkiewicz K, et al. ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  6. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.

    Article  PubMed  Google Scholar 

  7. Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis. 2014;56:391–400.

    Article  PubMed  Google Scholar 

  8. de Simone G, Izzo R, De Luca N, Gerdts E. Left ventricular geometry in obesity: is it what we expect? Nutr Metab Cardiovasc Dis. 2013;23:905–12.

    Article  PubMed  Google Scholar 

  9. Chirinos JA, Segers P, De Buyzere ML, et al. Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension. 2010;56:91–8. This paper introduced the allometric exponent of 1.7 which eliminated the residual negative relationship between LVM indexed to height 2.7 and height. Sex- and ethnic-specific thresholds of LVM indexed to body surface area and height 1.7, as well as comparisons of the prognostic values of LVM indexed to body surface area, height 2.7 and height 1.7 are provided.

  10. Sibiya MJ, Norton GR, Hodson B, et al. Gender-specific contribution of aortic augmentation index to variations in left ventricular mass index in a community sample of African ancestry. Hypertens Res. 2014;37:1021–7.

    Article  PubMed  Google Scholar 

  11. Booysen HL, Woodiwiss AJ, Sibiya MJ et al. Indexes of aortic pressure augmentation markedly underestimate the contribution of reflected waves toward variations in aortic pressure and left ventricular mass. Hypertension. 2015 (in press).

  12. de Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20:1251–60.

    Article  PubMed  Google Scholar 

  13. de Simone G, Kizer JR, Chinali M, et al. Normalization for body size and population—attributable risk of left ventricular hypertrophy. The Strong Heart Study. Am J Hypertens. 2005;18:191–6.

    Article  PubMed  Google Scholar 

  14. Paajanen TA, Oksala NK, Kuukasjarvi P, et al. Short stature is associated with coronary heart disease: a systematic review of the literature and a meta-analysis. Eur Heart J. 2012;31:1802–9.

    Article  Google Scholar 

  15. de Simone G, Devereux RB. Method errors or unexplained biological information? Hypertension. 2010;56:e177–8. This letter compared the prognostic values of LVM indexed to body surface area, height 2.7 and height 1.7 and emphasized the importance of population attributable risk.

  16. Poppe KK, Edgerton Bachmann M, Triggs CM, et al. Geographic variation in left ventricular mass and mass index: a systematic review. J Hum Hypertens. 2012;26:420–9.

    Article  CAS  PubMed  Google Scholar 

  17. Lang RM, Bierig M, Devereux R, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;8:1440–63.

    Article  Google Scholar 

  18. Aurigemma GP, de Simone G, Fitzgibbons TP. Cardiac remodelling in obesity. Circ Cardiovasc Imaging. 2013;6:142–52.

    Article  PubMed  Google Scholar 

  19. Messerli FH, Sundgaard-Riise K, Reisin E, et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med. 1983;99:757–61.

    Article  CAS  PubMed  Google Scholar 

  20. Bastien M, Poirier P, Lemieux I, Despres J-P. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56:369–81.

    Article  PubMed  Google Scholar 

  21. Gerdts E, de Simone G, Lund BP, et al. Impact of overweight and obesity on cardiac benefit of antihypertensive treatment. Nutr Metab Cardiovasc Dis. 2013;23:122–9.

    Article  CAS  PubMed  Google Scholar 

  22. Woodiwiss AJ, Libhaber CD, Majane OHI, et al. Obesity promotes left ventricular concentric rather than eccentric geometric remodeling and hypertrophy independent of blood pressure. Am J Hypertens. 2008;21:1144–52.

    Article  PubMed  Google Scholar 

  23. Turkbey EB, McClelland RL, Kronmal RA, et al. The impact of obesity on the left ventricle: the multi-ethnic study of atherosclerosis (MESA). JACC Cardiovasc Imaging. 2010;3:266–74. This large study (over 5000 participants) assessed the impact of obesity on left ventricular mass and geometry using cardiac magnetic resonance imaging (MRI), hence avoiding the possibility of poor echocardiographic windows in obesity.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Neeland IJ, Gupta S, Ayers CR, et al. Relation of regional fat distribution to left ventricular structure and function. Circ Cardiovasc Imaging. 2013;6:800–7. In this large study (2710 participants) dual energy x-ray absorptiometry and magnetic resonance imaging were used to assess fat distribution. Visceral adipose tissue (central obesity) was shown to be associated with concentric LV remodelling; whereas lower body subcutaneous fat was associated with eccentric LV remodelling.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kardassis D, Bech-Hanssen O, Schonander M, et al. The influence of body composition, fat distribution, and sustained weight loss on left ventricular mass and geometry in obesity. Obesity. 2012;20:605–11.

    Article  PubMed  Google Scholar 

  26. Cuspidi C, Rescaldani M, Sala C, Grassi G. Left-ventricular hypertrophy and obesity: a systematic review and meta-analysis of echocardiographic studies. J Hypertens. 2014;32:16–25. This is a meta-analysis of echocardiographic studies showing that although obesity is largely associated with eccentric LV remodelling, a significant proportion of concentric LV remodelling was also observed. It is important to note that no adjustments for either the presence of hypertension or blood pressure were made in these studies.

    Article  CAS  PubMed  Google Scholar 

  27. Khouri MG, Peshock RM, Ayers CR, et al. A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study. Circ Cardiovasc Imaging. 2010;3:129–31.

    Article  Google Scholar 

  28. Owan T, Avelar E, Morley K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57:732–9.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hsuan C-F, Huang C-K, Lin J-W, et al. The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity. 2010;18:1188–93. An intervention study assessing changes in LV mass and geometry 3 months after bariatric surgery, which showed that blood pressure reduction was the most important determinant of the regression of LV mass and relative wall thickness.

    Article  PubMed  Google Scholar 

  30. Luaces M, Cachofeiro V, Najar B+G-M-A, et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012;65:14–21.

    Article  PubMed  Google Scholar 

  31. Cuspidi C, Rescaldami M, Tadic M, et al. Effects of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Am J Hypertens. 2014;27:146–56. A meta-analysis of 23 bariatric surgery studies showing that a significant decrease in relative wall thickness (and hence a less concentric LV geometry) occurred together with reductions in LVM and LVM indexed to height 2.7.

  32. de las Fuentes L, Waggoner AD, Mohammed S, et al. Effect of moderate diet-induced weight loss and weight regain on cardiovascular structure and function. J Am Coll Cardiol. 2009;54:2376–86.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Rider OJ, Lewandowski A, Nethononda R, et al. Gender-specific differences in left ventricular remodelling in obesity: insights from cardiovascular magnetic resonance imaging. Eur Heart J. 2013;34:292–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. de Gonzalez BA, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2011;363:2211–9.

    Article  Google Scholar 

  35. Palatini P, Saladini F, Mos L, et al. Obesity is a strong determinant of hypertensive target organ damage in young-to-middle-age patients. Int J Obesity. 2013;37:224–9.

    Article  CAS  Google Scholar 

  36. Gidding SS, Liu K, Colangelo LA, et al. Longitudinal determinants of left ventricular mass and geometry: the coronary risk development in young adults (CARDIA) study. Circ Cardiovasc Imaging. 2013;6:769–75. This is a large (2426 participants) longitudinal study which identified the determinants of increases in LV mass and relative wall thickness over 20 years.

    Article  PubMed  Google Scholar 

  37. Avelar E, Cloward TV, Walker JM, et al. Left ventricular hypertrophy in severe obesity: interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension. 2007;49:34–9.

    Article  CAS  PubMed  Google Scholar 

  38. Norton GR, Majane OHI, Libhaber E, et al. The relationship between blood pressure and left ventricular mass index depends on an excess adiposity. J Hypertens. 2009;27:1873–83.

    Article  CAS  PubMed  Google Scholar 

  39. Simone G, Devereux RB, Izzo R, et al. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc. 2013;2:e000144. This is a longitudinal study which assessed the predictors of LVM regression.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Angela J. Woodiwiss and Gavin R. Norton declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

The authors data described in this article were part of studies conducted according to the principles outlined in the Helsinki declaration and approved by the Committee for Research on Human Subjects of the University of the Witwatersrand (approval numbers M02-04-72, renewed as M07-04-69 and M12-04-108). Participants gave informed consent. This article does not contain any studies with animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Angela J. Woodiwiss & Gavin R. Norton

  2. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa

    Angela J. Woodiwiss

Authors
  1. Angela J. Woodiwiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gavin R. Norton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela J. Woodiwiss.

Additional information

This article is part of the Topical Collection on Hypertension and Obesity

The authors are supported by the Medical Research Council of South Africa, the University Research Council of the University of the Witwatersrand, the National Research Foundation, the Circulatory Disorders Research Trust, and the Carnegie Corporation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Woodiwiss, A.J., Norton, G.R. Obesity and Left Ventricular Hypertrophy: The Hypertension Connection. Curr Hypertens Rep 17, 28 (2015). https://doi.org/10.1007/s11906-015-0539-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-015-0539-z

Keywords

Search

Navigation