Differences in left ventricular structure, functions and elastance in the patients with normotensive blood pressure

We aimed in this study to investigate the differences in left ventricular (LV) structure, function and elastance parameters in the patients with normotensive blood pressure (BP) levels.

A total of 294 normotensive patients (<140/90 mmHg) (135 males, mean age: 45+/-11 years; 159 females, mean age 38+/-10 years) were enrolled into the present cross-sectional study. Patients were categorized into three groups according to their BP levels as optimal BP (<120/80 mmHg), normal BP (120-129 / 80-84 mmHg) and high normal BP (129-139 / 84-89 mmHg) groups. We evaluated LV structure and functions by using Doppler echocardiography in all participants. Afterwards we compared the measurements for revealing the echocardiographic differences among the BP groups. In this study, one-way ANOVA Kruskal-Wallis, one-way ANCOVA and partial correlation analysis tests were used for the statistically evaluation of the data. In addition, relative risk ratios (RR) were also calculated for determination of the effects of BP levels to echocardiographic parameters.

There were significant statistical differences in left atrial diameter (LA) (p=0.002), transmitral A wave velocity (A) (p=0.002), meridional wall stress (MWS) (p<0.001), pulmonary capillary wedge pressure (PCW) (p=0.029) among BP groups. After the correction of the data for anthropometric measurements, multiple comparisons have shown that only end-systolic (Es) and end-diastolic elastance (Ed) were different between the normal and high-normal BP groups (for Es, p=0.013; for Ed, p=0.007). But it was found that optimal BP group had significant differences in LV structure and function parameters when compared to high normal BP group (for LA, p=0.028; for A, p=0.035; for MWS, p=0.002; for Es, p<0.001; for Ed, p<0.001). Besides, increased RR were detected for increased left atrial diameter index and pulmonary capillary wedge pressure values in high-normal BP group (RR: 1.537, 95% CI (1.197-1.974), p=0.005 and RR: 1.272, 95% CI (1.089-1.485), p=0.032, respectively).

Pathologic changes in LV due to increasing BP begin at below-hypertensive BP levels. It could be possible that normal BP stage is the beginning level of these changes.