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Correlates of diastolic filling abnormalities in hypertension: a Doppler echocardiographic study
J Szlachcic1, J F Tubau, B O'Kelly
1Department of Medicine, University of California, San Francisco.
Insights
Hypertension causes abnormal left ventricular diastolic filling, independent of aging or LV hypertrophy. These changes suggest altered myocardial properties or hemodynamic load contribute to diastolic dysfunction in hypertensive patients.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Hypertension and aging are linked to left ventricular (LV) diastolic dysfunction and increased LV mass.
- Diastolic filling abnormalities are common in aging and hypertensive individuals.
Purpose of the Study:
- To investigate if diastolic filling abnormalities in hypertension exist independently of aging and significant LV hypertrophy.
- To differentiate the effects of hypertension, aging, and LV mass on diastolic function.
Main Methods:
- Studied 19 untreated hypertensive patients and 18 age- and LV mass-matched normotensive controls.
- Assessed systolic function and ejection fraction using radionuclide angiography.
- Measured early filling (E) and late filling (A) velocities and their ratio (E/A) via Doppler echocardiography.
Main Results:
- Hypertensive patients exhibited abnormal filling indices (E, A, E/A) compared to normotensive controls.
- No significant correlation was found between filling indices and LV mass in hypertensive patients.
- Early filling (E) showed inverse correlation with age and diastolic blood pressure in normotensive individuals, but not in hypertensive patients.
- Late filling (A) was influenced by septal wall thickness and blood pressure in both groups.
- The E/A ratio correlated inversely with age in both normotensive and hypertensive subjects.
Conclusions:
- Diastolic filling abnormalities in hypertension are not solely due to LV hypertrophy or aging.
- Altered myocardial properties or increased hemodynamic load likely contribute to diastolic dysfunction in hypertension.
- Findings highlight the complex interplay of factors affecting diastolic function in hypertensive individuals.
Abstract:
Hypertension and aging are both associated with changes of left ventricular (LV) diastolic filling and increased LV mass. To determine whether diastolic filling abnormalities are present in hypertension independent of aging and significant hypertrophy, we studied 19 hypertensive patients following a period of 4 weeks when they were not receiving therapy and 18 normotensive subjects matched for sex, age, and LV mass. All subjects had normal systolic function and ejection fraction as assessed by radionuclide angiography. We measured peak velocity of early filling (E), late filling (A), and their ratio (E/A) by Doppler echocardiography. Filling indices were abnormal in hypertensive patients, but none of the filling indices were significantly correlated with LV mass. E was inversely related to age (r = -0.62; p less than 0.01) and diastolic blood pressure (r = 0.45; p less than 0.05) in normotensive individuals, but these correlations were not significant in hypertensive patients. E was not significantly correlated to LV mass or wall thickness. In contrast, A was influenced by septal wall thickness and blood pressure in both groups. E/A correlated inversely with age in both normal individuals (r = -0.74) and hypertensive patients (r = -0.51). These findings indicate that diastolic filling abnormalities in hypertension are not solely caused by either LV hypertrophy or by aging and therefore must be in part related to the hemodynamic load or altered myocardial or chamber properties.