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Echo-Doppler assessment of left ventricular filling in borderline hypertension
C Marabotti1, A Genovesi-Ebert, C Palombo
1C.N.R. Institute of Clinical Physiology, Pisa, Italy.
Insights
Early hypertension affects heart structure and function. Borderline hypertension shows increased left ventricular wall thickness and impaired diastolic function, indicating early cardiac changes in hypertensive heart disease.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Essential hypertension can lead to cardiac structural and functional alterations.
- Early detection of these changes is crucial for managing hypertensive heart disease.
Purpose of the Study:
- To assess left ventricular (LV) anatomy and diastolic function in individuals with borderline essential hypertension.
- To compare these parameters with normotensive controls and patients with established hypertension.
Main Methods:
- Echocardiography and pulsed-wave Doppler were used to evaluate 16 borderline hypertensive patients.
- Transmitral blood flow indices of LV diastolic function were measured.
- Control groups included 20 normotensive and 20 established hypertensive individuals.
Main Results:
- Borderline hypertensives exhibited increased interventricular septum and posterior wall thickness compared to normotensives.
- Diastolic function analysis revealed significantly higher late (A) peak flow velocity and A/E ratios, and lower early filling fraction (EFF) in borderline hypertensives versus normotensives.
- These diastolic changes were independent of age.
Conclusions:
- Diastolic dysfunction is an early manifestation in borderline hypertension, confirming its presence in hypertensive heart disease.
- Increased LV wall thickness in borderline hypertension suggests that anatomical modifications may accompany early functional changes, challenging the notion of their complete independence.
Abstract:
The aim of this study was to evaluate left ventricular anatomy and diastolic function in borderline essential hypertension. To this aim, 16 borderline hypertensive patients underwent echocardiographic and pulsed-wave Doppler evaluation. As control groups, 20 normotensive controls and 20 patients with established hypertension were evaluated by the same procedure. By the Doppler assessment of transmitral blood flow, the following indices of left ventricular diastolic function were obtained: early (E) and late (A) peak flow velocity, late to early velocity ratio (A/E), early filling fraction (EFF) and acceleration and deceleration times of early and late flow peaks. Borderline hypertensives had an interventricular septum and posterior wall thickness significantly higher than normotensives and lower than established hypertensives. As regards the diastolic indexes, borderline hypertensive patients had significantly higher A peaks (P less than .02) and A/E ratios (P = .05) and lower EFF (P less than .02) as compared to normotensive controls. No significant differences were on the other hand observed with established hypertensive patients. This resultant diastolic pattern was independent of age, as indicated by the analysis of age-matched subgroups. The presence of diastolic function changes in borderline hypertension confirms the early appearance of this kind of abnormality in hypertensive heart disease. On the other hand, the finding of increased left ventricular wall thickness in borderline hypertensives does not allow us to conclude that, as suggested by other authors, diastolic function changes in the early stage of hypertension are independent on anatomical modifications.(ABSTRACT TRUNCATED AT 250 WORDS)