Differential relationships of systolic and diastolic blood pressure with components of left ventricular diastolic
Carlos D Libhaber1, Angela J Woodiwiss, Hendrik L Booysen
1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Diastolic blood pressure (DBP) is linked to early diastolic dysfunction (E/A), while systolic blood pressure (SBP) relates to impaired myocardial relaxation (E/e'). Both SBP and DBP impact diastolic function, even in normal ranges.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular diastolic dysfunction (LVDD) is a significant clinical issue.
- Understanding the role of different blood pressure components (SBP and DBP) in LVDD is crucial for early detection and management.
Purpose of the Study:
- To investigate the association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with specific echocardiographic measures of left ventricular diastolic dysfunction.
- To determine which blood pressure component is more strongly related to different aspects of diastolic dysfunction.
Main Methods:
- 241 participants underwent echocardiography to assess diastolic function using E/A and E/e' ratios.
- Brachial and central aortic blood pressure measurements were taken.
- Statistical analyses explored relationships between BP components and diastolic function parameters, adjusting for confounders.
Main Results:
- Brachial diastolic blood pressure (DBP) was independently associated with the E/A ratio (a measure of early diastolic filling), even after adjusting for SBP.
- Systolic blood pressure (SBP) was independently associated with E/e' (a measure of myocardial relaxation), even after adjusting for DBP.
- These associations were observed even within normal to high-normal blood pressure ranges.
Conclusions:
- Both SBP and DBP are significant determinants of distinct components of left ventricular diastolic dysfunction.
- DBP's association with E/A suggests its importance in the early stages of diastolic dysfunction, potentially equal to SBP's role in impaired relaxation.
Aims:
To determine whether SBP or DBP is best associated with different components of left ventricular diastolic dysfunction.
Methods:
In 241 randomly selected participants, echocardiographic left ventricular diastolic function was assessed from early-to-atrial (E/A) transmitral velocity and E/e' where e' represents myocardial tissue lengthening velocity in early diastole as measured at the mitral annulus. Relationships between diastolic function and blood pressure (BP) were assessed from brachial and central aortic (radial applanation tonometry and SphygmoCor software) measurements.
Results:
Independent of confounders, brachial DBP (partial r = -0.21, P < 0.002), but not SBP (partial r = -0.09, P = 0.18), was associated with E/A and the relationship between brachial DBP and E/A persisted with adjustments for brachial (P < 0.002) or aortic (P < 0.05) SBP. Although aortic SBP was independently associated with E/A, this relationship did not persist with adjustments for DBP (partial r = -0.05, P = 0.44). In contrast, both brachial (partial r = 0.34, P < 0.0001) and aortic (partial r = 0.34, P < 0.0001) SBP were independently associated with E/e', effects that persisted with adjustments for DBP (P < 0.0001), although independent relationships between DBP and E/e' did not persist with adjustments for brachial or aortic SBP (P = 0.17-0.57). In quartiles of DBP or SBP within normal-to-high normal ranges, multivariate adjusted E/A was decreased and E/e' increased as compared with those with optimal BP values (P < 0.05 to P < 0.005).
Conclusion:
Both SBP and DBP are important determinants of separate components of left ventricular diastolic dysfunction and these effects are noted even within normotensive BP ranges. DBP may be as important as SBP in the transition to diastolic dysfunction.
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