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Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension
B C Aeschbacher1, D Hutter, J Fuhrer
1Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Switzerland.
Insights
Young men with a genetic risk for hypertension showed early signs of diastolic dysfunction on echocardiograms over five years. These changes occurred without increased left ventricular mass, even in those who developed mild hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Systemic hypertension can lead to early left ventricular (LV) hypertrophy and diastolic dysfunction.
- Longitudinal studies investigating these early changes are limited.
Purpose of the Study:
- To longitudinally assess echocardiographic changes in LV diastolic function in young, normotensive men with a parental history of hypertension.
- To compare these changes with offspring of normotensive parents over a 5-year period.
Main Methods:
- A 5-year follow-up echocardiographic study was conducted on young, initially normotensive male offspring of hypertensive (OHyp) and normotensive (ONorm) parents.
- Measurements included blood pressure, LV mass, mitral inflow, pulmonary vein flow, and septal myocardial Doppler imaging.
Main Results:
- At follow-up, blood pressure did not differ significantly between groups, though five OHyp developed mild hypertension.
- Left ventricular mass index remained unchanged and similar between groups.
- Diastolic function showed alterations in OHyp, including prolonged mitral E deceleration time and pulmonary vein reverse A wave duration.
- These diastolic alterations were more pronounced in OHyp who developed hypertension, despite similar LV mass.
Conclusions:
- Young men with a genetic predisposition to hypertension exhibit Doppler echocardiographic evidence of LV diastolic dysfunction over 5 years.
- These diastolic alterations occur without significant changes in LV mass and are more pronounced in individuals who develop hypertension.
Background:
Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in systemic hypertension, but longitudinal studies are missing.
Methods:
We performed an echocardiographic follow-up study in young initially normotensive male offspring of hypertensive (OHyp) (n = 25) and normotensive (ONorm) (n = 17) parents. Blood pressure (BP), LV mass, and mitral inflow were determined at baseline and after 5 years. Pulmonary vein flow pattern assessment and septal myocardial Doppler imaging were additionally performed at follow-up.
Results:
At follow-up, BP was not significantly different between the two groups (128 +/- 11/84 +/- 10 v 123 +/- 11/81 +/- 5 mm Hg, OHyp v ONorm) but five OHyp had developed mild hypertension. LV mass index remained unchanged and was not different between the two groups at follow-up (92 +/- 17 v 92 +/- 14 g/m2). Diastolic echocardiographic properties were similar at baseline, but, at follow-up, the following differences were found: mitral E deceleration time (209 +/- 32 v 185 +/- 36 msec, P < .05) and pulmonary vein reverse A wave duration (121 +/- 15 v 107 +/- 12 msec, P < .05) were prolonged in the OHyp as compared to the ONorm. Compared to the normotensive subjects, the five OHyp who developed hypertension had more pronounced alterations of LV diastolic function, that is, significantly higher mitral A (54 +/- 7 v 44 +/- 9 cm/sec, hypertensives v normotensives, P < .05), lower E/A ratio (1.31 +/- 0.14 v 1.82 +/- 0.48, P < .05), increased systolic-to-diastolic pulmonary vein flow ratio (1.11 +/- 0.3 v 0.81 +/- 0.16, P < .005), longer myocardial isovolumic relaxation time (57 +/- 7 v 46 +/- 12 msec, P < .05) as well as smaller myocardial E (10 +/- 1 v 13 +/- 2 cm/sec, P < .05) and E/A ratio (1.29 +/- 0.25 v 1.78 +/- 0.43, P < .05), despite similar LV mass (91 +/- 16 v 93 +/- 18 g/m2).
Conclusions:
Over a 5-year follow-up, initially lean, normotensive, young men with a moderate genetic risk for hypertension, developed Doppler echocardiographic alterations of LV diastolic function compared to matched offspring of normotensive parents. These alterations were more pronounced in the OHyp who developed mild hypertension and occurred without a distinct rise in LV mass.