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Ambulatory blood pressure and metabolic abnormalities in hypertensive subjects with inappropriately high left
V Palmieri1, G de Simone, M J Roman
1Division of Cardiology and Hypertension Center, Department of Medicine, New York Presbyterian Hospital, Joan and Sanford I. Well Medical College of Cornell University, New York, NY, USA.
Insights
Inappropriately high left ventricular (LV) mass in hypertension is linked to higher body mass index, increased ambulatory blood pressure, and reduced heart function. These findings highlight key factors associated with cardiac remodeling in hypertensive individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Physiology
Background:
- Assessing left ventricular (LV) mass appropriateness to cardiac workload is crucial in hypertension.
- The ratio of observed LV mass to predicted LV mass for an individual's gender, height, and stroke work (%PLVM) is a key metric.
- Pathophysiological factors linked to inappropriately high LV mass in hypertensive subjects remain unclear.
Purpose of the Study:
- To identify pathophysiological factors associated with inappropriately high left ventricular (LV) mass in hypertensive subjects.
- To compare characteristics of hypertensive individuals with adequate, high, and low LV mass relative to cardiac workload.
- To explore correlates of increased and decreased LV mass appropriateness in arterial hypertension.
Main Methods:
- Defined adequate LV mass using the 90% confidence interval of %PLVM in normotensive subjects.
- Evaluated 185 hypertensive subjects for LV mass appropriateness (%PLVM).
- Compared demographic, metabolic, and hemodynamic parameters between groups with adequate and inappropriately high LV mass, including ambulatory blood pressure monitoring and echocardiography.
Main Results:
- 88% of hypertensive subjects had adequate LV mass, 9% had inappropriately high LV mass, and 3% had low LV mass.
- Inappropriately high LV mass was associated with higher body mass index, higher fasting glucose, higher proportion of black subjects, and lower HDL cholesterol.
- Subjects with inappropriately high LV mass exhibited higher ambulatory blood pressure, larger aortic root dimensions, increased LV relative wall thickness, and lower LV systolic performance compared to those with adequate LV mass.
Conclusions:
- Inappropriately high left ventricular (LV) mass in arterial hypertension is associated with higher body mass index, increased ambulatory blood pressure, larger aortic root diameters, and reduced myocardial contractility.
- Higher body mass index, larger aortic root diameter, and black race are independent correlates of increased %PLVM.
- These findings underscore the importance of considering body composition, ambulatory blood pressure, and cardiac structure in managing hypertensive heart disease.
Abstract:
Appropriateness of left ventricular (LV) mass to cardiac workload can be evaluated by the ratio of observed LV mass to the value predicted for an individual's gender, height(2.7), and stroke work at rest (%PLVM). It is unclear which pathophysiological factors are associated with inappropriately high LV mass in hypertensive subjects. Adequate LV mass was defined by the 90% confidence interval (73% to 128%) of the distribution of %PLVM in 393 normal-weight normotensive subjects. In 185 hypertensive subjects (aged 56+/-11 years; 60% male, 29% black), according to %PLVM, 164 (88%) had adequate LV mass, 16 (9%) had inappropriately high LV mass (%PLVM >128%), and 5 (3%) had %PLVM <73% (low LV mass). Age, gender, smoking habit, proportion of never-treated subjects, total cholesterol, triglycerides, and creatinine levels did not differ significantly between subjects with adequate and inappropriately high LV mass. Body mass index, fasting glucose, and proportion of black subjects were higher (all P<0.05), while HDL cholesterol was lower (P<0.05) in subjects with inappropriately high LV mass. Blood pressure at the echocardiogram was comparable between subjects with adequate and inappropriately high LV mass, but the latter group had higher ambulatory blood pressure (P<0.01). Subjects with inappropriately high LV mass also had higher aortic root dimension and LV relative wall thickness and relatively lower LV systolic performance than those with adequate LV mass (all P<0.001). Larger aortic root diameter and lower systolic function were also found in hypertensive subjects with inappropriate LV hypertrophy compared with those with adequate LV hypertrophy. In an exploratory case-control study that compared subjects with low %PLVM with age-matched counterparts with adequate LV mass, low %PLVM was associated with lower body mass index, more favorable metabolic profile, and higher LV myocardial contractility. Higher body mass index, larger aortic root, and black race were independent correlates of increased %PLVM. Thus, in arterial hypertension, levels of LV mass inappropriately high for gender, cardiac workload, and height(2.7) are associated with higher body mass index, higher ambulatory blood pressure, larger aortic root diameters, and relatively low myocardial contractility.
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