Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive
P Verdecchia1, G Schillaci, M Guerrieri
1Civic Hospital Beato G. Villa, Division of Medicine, Città della Pieve PG, Italy.
Insights
Age and ambulatory blood pressure are key factors affecting diastolic filling abnormalities in hypertension. These Doppler-identified issues occur in nearly half of hypertensive patients, independent of left ventricular hypertrophy.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Essential hypertension is a significant risk factor for cardiovascular disease.
- Left ventricular diastolic dysfunction is a common complication of hypertension.
- Early detection of diastolic abnormalities is crucial for managing hypertensive heart disease.
Purpose of the Study:
- To investigate the independent determinants of left ventricular diastolic filling abnormalities in essential hypertension.
- To assess the prevalence of Doppler-detected diastolic dysfunction in an unselected hypertensive population.
- To explore the relationship between echocardiographic parameters, clinical factors, and diastolic function.
Main Methods:
- 250 subjects (145 hypertensives, 105 controls) underwent Doppler echocardiography and 24-h ambulatory blood pressure monitoring.
- Transmitral flow velocities (early and late diastolic), deceleration times, and ratios were analyzed.
- Stepwise multivariate regression identified independent predictors of diastolic dysfunction.
Main Results:
- Hypertensive patients showed abnormal early and late diastolic transmitral flow velocities and deceleration patterns compared to controls.
- Up to 46% of hypertensive patients exhibited abnormal age-corrected Doppler values, irrespective of left ventricular hypertrophy.
- Age and ambulatory blood pressure (daytime/night-time) were independently associated with diastolic filling parameters.
Conclusions:
- Doppler abnormalities in diastolic transmitral blood flow are prevalent in essential hypertension, even with low rates of left ventricular hypertrophy.
- Age and ambulatory blood pressure are the primary independent determinants of these diastolic abnormalities.
- Clinic blood pressure, sex, hypertension duration, and left ventricular mass were not independent predictors.
Abstract:
The independent contribution of age, sex, duration of hypertension, heart rate, clinic and ambulatory blood pressure and echocardiographic left ventricular mass to left ventricular diastolic filling abnormalities in essential hypertension was investigated in 250 subjects (145 untreated and unselected hypertensives and 105 healthy normotensive controls) undergoing Doppler and standard echocardiography and non-invasive 24-h ambulatory blood pressure monitoring. Late and early diastolic transmitral peak flow velocities and their ratio (all P less than 0.01), the rate of deceleration of early diastolic mitral flow (P less than 0.01) and the time of deceleration of early diastolic mitral flow (P = 0.018) were abnormal in the hypertensive group vs controls. None of these parameters significantly varied in the presence vs absence of LV hypertrophy. In the hypertensive group, the prevalence of abnormal age-corrected Doppler values varied up to 46% (up to 45.4% and 50% in the absence and presence of left ventricular hypertrophy, respectively; P = n.s.). In a stepwise multivariate regression analysis, age and average daytime or night-time ambulatory blood pressure showed a significant independent relationship with each of these Doppler indexes of left ventricular diastolic filling. Late transmitral peak flow velocity and the ratio of late to early peak flow velocity were also independently affected by the heart rate. Sex, duration of hypertension, clinic systolic and diastolic blood pressure and left ventricular mass index did not show any independent relationship to these Doppler parameters of left ventricular filling. In conclusion, Doppler abnormalities of diastolic transmitral blood flow were detected in up to 46% of patients in an unselected hypertensive population with a low prevalence (14.5%) of left ventricular hypertrophy. Age and ambulatory blood pressure, but not sex, duration of hypertension, clinic blood pressure and left ventricular mass itself, were the major independent determinants of these abnormalities.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:22Mitral Stenosis I: Introduction
01:29Heart Failure II: Pathophysiology
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:28Hypertension I: Introduction
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies