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Organ damage in treated middle-aged hypertensives compared to normotensives: results from a cross-sectional study in
I Enström1, I M Burtscher, J Eskilsson
1Kävlinge Health Centre, Sweden.
Insights
Treated hypertension in middle-aged adults is linked to significant organ damage, including increased left ventricular mass and retinal vessel changes. Further research is needed to determine if earlier or more intensive blood pressure management could prevent these effects.
Area of Science:
- Cardiology
- Neurology
- Ophthalmology
Background:
- High blood pressure (hypertension) is a major risk factor for organ damage.
- Advances in hypertension treatment and organ imaging have improved patient outcomes.
- The study investigates organ-specific changes in treated hypertensive individuals.
Purpose of the Study:
- To compare heart, brain, and retinal status in middle-aged treated hypertensives versus normotensives.
- To identify subclinical organ damage associated with treated hypertension.
- To assess the impact of hypertension on cardiovascular and cerebrovascular health.
Main Methods:
- Echocardiography for cardiac assessment (left ventricular mass, atrial size, diastolic function).
- Retinal photography to evaluate vascular changes.
- Magnetic resonance imaging (MRI) for brain imaging (white matter and periventricular changes).
Main Results:
- Treated hypertensives showed significantly higher left ventricular mass and left atrial size compared to normotensives.
- Hypertensives exhibited impaired left ventricular diastolic function and more frequent retinal arterial narrowing.
- Brain MRI revealed significantly more white matter and/or periventricular changes in hypertensives.
Conclusions:
- Treated hypertension is associated with significant cardiac, retinal, and brain structural changes.
- These findings highlight the persistent risk of organ damage despite medical treatment.
- The potential benefits of earlier or more aggressive antihypertensive therapy warrant further investigation.
Background:
High blood pressure contributes to organ damage. However, during the past two decades there have been great advances in the medical treatment of hypertension. Technical progress has also made it easier to visualize organ damage. Hence we found it of interest to examine heart, brain and retina in a group of middle-aged treated hypertensives, comparing the results with those from a group of middle-aged normotensives.
Methods:
The subjects were 40 (20 men) treated hypertensives and 40 (20 men) normotensives, who had previously taken part in a study in which ambulatory blood pressure monitoring had been performed. The heart was examined by echocardiography, the retina by photography and the brain by magnetic resonance imaging.
Results:
Office blood pressure and 24-h systolic/diastolic blood pressure (S/D) were 141/86 (13/7) mmHg and 128/81 (11/6) mmHg in the hypertensives and 125/78 (10/8) mmHg and 118/74 (8/5) mmHg in the normotensives, respectively. Left ventricular mass was 101 (27) g/m2 in the hypertensives and 85 (18) g/m2 in the normotensives (p = 0.0025). The corresponding figures for the left atrium were 21.1 (3.1) mm/m2 in the hypertensives and 19.5 (2.2) mm/m2 in the normotensives (p < 0.001). E/A wave quotient was 1.09 (0.26) in the hypertensives and 1.26 (0.26) in the normotensives (p = 0.0045), while left ventricular systolic function did not differ between the groups. Ten hypertensives and one normotensive subject had left ventricular mass above normal range. Narrow retinal arteries were found in 22 hypertensives and 8 normotensives (p < 0.001). Brain magnetic resonance changes (deep white matter and/or periventricular) were found in 19 hypertensives and 9 normotensives (p = 0.0431).
Conclusions:
The hypertensives differed significantly from the normotensives concerning left ventricular mass, left atrium, left ventricular diastolic function and retinal vessel changes. Deep white matter and periventricular changes in the brain were also significantly different in the two groups. We can only speculate as to whether earlier antihypertensive treatment or further blood pressure reduction could have affected these differences.