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Prevalence of cardiac structural and functional abnormalities in untreated primary hypertension
E Laufer1, G L Jennings, P I Korner
1Clinical Research Unit, Alfred Hospital and Baker Medical Research Institute, Melbourne, Australia.
Insights
Hypertension often causes cardiac abnormalities. Echocardiography revealed significant left ventricular structural and functional changes in most patients with established or mild hypertension, impacting heart health.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Left ventricular abnormalities are common sequelae of sustained blood pressure elevation.
- Early detection of cardiac changes in hypertensive individuals is crucial for management.
Purpose of the Study:
- To determine the prevalence of left ventricular structural and functional abnormalities in untreated hypertensive patients.
- To compare cardiac findings between normal volunteers and patients with established or mild hypertension.
- To assess the utility of echocardiography in identifying hypertensive heart disease.
Main Methods:
- Echocardiography was performed on 89 normal volunteers, 57 established hypertension patients, and 38 mild hypertension patients.
- Key measurements included left ventricular mass, wall thickness, internal diameter, and transmitral flow velocities.
- Covariance analysis was used to adjust for body size and age.
Main Results:
- 30% of established hypertension patients and 12-15% of mild hypertension patients showed increased left ventricular mass index.
- Left ventricular wall thickness abnormalities were found in 65% (established) and 32% (mild) hypertension groups.
- Transmitral flow velocity abnormalities were present in 28% (established) and 12% (mild) hypertension groups.
Conclusions:
- The majority of hypertensive patients exhibit cardiac structural or functional abnormalities.
- Echocardiography is effective in detecting these abnormalities, even in mild or untreated hypertension.
- Multivariate analysis combining anatomic and functional data offers reliable classification of hypertensive heart disease.
Abstract:
We examined the prevalence of left ventricular structural and functional abnormalities in previously untreated subjects by performing echocardiography in 89 normal volunteers, 57 patients with established hypertension, and 38 patients with mild or borderline hypertension. We measured left ventricular mass, wall thickness, internal diameter, and wall thickness/radius ratio. Because of intergroup differences in body size, we used covariance analysis to index these variables to a common value of 1.8 m2. No adjustment was needed for the wall thickness/radius ratio. Functional variables determined were fractional shortening and transmitral early/late flow velocity ratio (the latter was standardized by analysis of covariance to age 40 years). The prevalence of left ventricular mass index values more than 2 SD above the mean of the normal group was 30% in the patients with established hypertension and 12-15% in the patients with mild hypertension. Corresponding figures for wall thickness index were 65% and 32% and for the wall thickness/radius ratio 60% and 40%. The prevalence of abnormality in the transmitral flow velocity was 28% in the patients with established hypertension and 12% in the patients with mild hypertension. A multivariate discriminant function that used combined anatomic and functional variables provided the most reliable classification; it was correct in 82% of normal subjects, 65% of patients with established hypertension, and 61% of patients with mild hypertension. The majority of patients with hypertension have cardiac structural or functional abnormalities, or both.