Sex-related differences in left ventricular geometry patterns in patients with arterial hypertension

Abstract Background Sex-specific differences in left ventricular (LV) geometry is key for tailoring management strategies for arterial hypertension. Purpose To evaluate sex-related differences in LV geometry patterns at baseline and their evolution over time in hypertension. Methods From a prospective registry, we included hypertensive patients with at least 1 year follow-up, without prevalent cardiovascular disease or incident myocardial infarction, with normal LV ejection fraction and no chronic kidney disease of stage III or more. Four LV geometry patterns were assessed: normal geometry, concentric remodeling, eccentric and concentric LV hypertrophy (LVH). Results A total of 6427 patients (age 53±11 years, 43% females) were included. At baseline, a normal geometric pattern was less common in female than in male patients (50% vs. 72%, p<0.001). LVH was more prevalent among female than male patients (47% vs. 23%, p<0.001), with a higher prevalence of eccentric LVH (40% vs. 18%, p<0.001). Female sex was independently associated with LV remodeling (odds ratio, 2.36, 95% confidence intervals, 2.12-2.62, p<0.001). At long-term follow-up (mean 6.1 years, IQR 2.8-8.6 years), the proportion of patients with LV remodeling increased in both sexes, although a normal LV geometry remained less frequent in female than male patients (43% vs. 67%, p<0.001), with differences persisting in eccentric (41% vs. 21%, p<0.001) and concentric LVH (11% vs. 5%, p<0.001). Conclusions We found relevant sex-related differences in LV geometry among patients with hypertension. Females have a higher risk of LV remodeling at baseline compared with men, with differences persisting at long-term follow-up.