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Pulse pressure and echocardiographic findings in essential hypertension
B Pannier1, P Brunel, W el Aroussy
1Diagnosis Center, Broussais Hospital, Paris, France.
Insights
Increased pulse pressure in hypertension may drive cardiac hypertrophy, independent of mean arterial pressure. This suggests pulse pressure impacts cardiac mass by affecting ventricular ejection and impedance.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Physiology
Background:
- Sustained essential hypertension is associated with cardiovascular changes.
- Cardiac mass and arterial stiffness are key indicators of cardiovascular risk.
- The specific role of pulse pressure in hypertensive cardiac remodeling requires further elucidation.
Purpose of the Study:
- To investigate the relationship between pulse pressure and cardiac mass in patients with essential hypertension.
- To determine if increased pulse pressure influences cardiac hypertrophy independently of mean arterial pressure and aortic distensibility.
Main Methods:
- Evaluated blood pressure, carotid-femoral pulse wave velocity, and cardiac mass via echocardiography.
- Compared 36 hypertensive patients (divided by pulse pressure <60 mmHg vs. >=60 mmHg) with 11 normal subjects.
- Ensured comparable age, weight, height, and mean arterial pressure between hypertensive groups.
Main Results:
- Hypertensive patients with higher pulse pressure (Group II) showed significantly greater cardiac mass than those with lower pulse pressure (Group I).
- Mean arterial pressure and pulse wave velocity were similar between the two hypertensive groups.
- Stroke volume was significantly higher in the high pulse pressure group compared to normal subjects.
Conclusions:
- Increased pulse pressure in hypertension may independently contribute to cardiac hypertrophy.
- This effect could stem from disturbances in ventricular ejection and impedance, leading to increased pulsatile energy loss.
- Pulse pressure is a critical factor to consider in the development of hypertensive heart disease.
Abstract:
Blood pressure, carotid-femoral pulse wave velocity and cardiac mass as judged on echocardiography were evaluated in 11 normal subjects and 36 patients with sustained essential hypertension of similar age. The hypertensive patients were divided into two groups of similar age, weight, height and mean arterial pressure: patients in the first group (Group I) had a pulse pressure inferior to 60 mmHg and in the second group (Group II) had a pulse pressure equal or superior to this value. Group II patients had significant higher values for cardiac mass (148.8 +/- 44.3 vs 116.3 +/- 19.8 g/m2; P less than 0.01) (+/- 1 s.d.) than Group I, while mean arterial pressure and pulse wave velocity were similar in the two groups. Stroke volume was significantly higher in Group II than in normal subjects (99.5 +/- 17.1 versus 82.7 +/- 16.9 ml; P less than 0.05). The study findings suggested that the increased pulse pressure in hypertensive patients might influence the development of cardiac hypertrophy independently of mean arterial pressure and aortic distensibility. The increased pulse pressure could reflect a disturbance between ventricular ejection and impedance affecting the ventricle with a resulting increase in pulsatile energy losses and further increase in cardiac mass.