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Left ventricular diastolic function predicts outcome in uncomplicated hypertension
1Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven KU Leuven, Belgium. robert.fagard@uz.kuleuven.ac.be
Insights
Elevated pulmonary wedge pressure, indicating impaired diastolic function, significantly predicts mortality and cardiovascular events in hypertension patients. This finding is independent of other risk factors, highlighting its importance for risk assessment.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Hemodynamics
Background:
- Left ventricular systolic function is a known predictor of outcomes in hypertensive patients without heart failure.
- The prognostic value of left ventricular diastolic function in uncomplicated hypertension has not been previously established.
Purpose of the Study:
- To evaluate the relationship between mean pulmonary capillary wedge pressure, an index of left ventricular diastolic function, and mortality.
- To assess the association of mean pulmonary capillary wedge pressure with the incidence of cardiovascular events in patients with uncomplicated hypertension.
Main Methods:
- Invasive hemodynamic measurements were conducted in 172 hypertensive patients without cardiovascular disease or heart failure between 1972 and 1982.
- Mean pulmonary capillary wedge pressure was measured as an indicator of left ventricular diastolic function.
- Patient outcomes, including mortality and cardiovascular events, were followed up until 1994 using Cox regression analysis.
Main Results:
- During 2675 patient-years of follow-up, 15 deaths and 34 cardiovascular events occurred.
- Mean pulmonary wedge pressure significantly predicted total mortality (P < .05) and cardiovascular events, independent of age and gender.
- A 1 mm Hg increase in wedge pressure was linked to a 23% rise in all-cause mortality and a 13% rise in cardiovascular event risk.
Conclusions:
- Mean pulmonary wedge pressure is a significant and independent predictor of mortality and cardiovascular events in patients with uncomplicated hypertension.
- Diastolic dysfunction, as indicated by elevated pulmonary wedge pressure, plays a crucial role in cardiovascular risk stratification for hypertensive individuals.
Abstract:
Whereas left ventricular systolic function has been shown to predict outcome in hypertensive patients without clinical evidence of heart failure, the prognostic power of diastolic function has not been examined. We assessed the relation of mean pulmonary capillary wedge pressure as an index of left ventricular diastolic function to mortality and the incidence of cardiovascular events in patients with uncomplicated hypertension at baseline. Invasive hemodynamic measurements were performed in the period 1972 to 1982 in 172 hypertensive patients without evidence of cardiovascular disease, cardiomegaly or heart failure, and their outcome was ascertained in 1994. Age at baseline averaged 37 +/- 12 years, brachial artery pressure was 162 +/- 30/88 +/- 18 mm Hg, and mean pulmonary wedge pressure 6.3 +/- 3.0 mm Hg. During 2675 patient-years of follow-up, 15 patients died and 34 suffered at least one fatal or nonfatal cardiovascular event. Cox regression analysis showed that pulmonary wedge pressure was a significant predictor of total mortality and of cardiovascular events, after control for age and gender (P < .05). Each 1 mm Hg increase in wedge pressure was associated with a 23% increase in the risk of all-cause mortality and a 13% increase in the risk of a cardiovascular event. The prognostic power was independent of mean brachial artery pressure, body mass index, serum cholesterol, electrocardiographic left ventricular hypertrophy, and smoking at baseline. We conclude that mean pulmonary wedge pressure, which is likely to reflect left ventricular diastolic function in the selected patients of the current study, is a significant and independent predictor of mortality and of cardiovascular events in uncomplicated hypertension.