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Determinants of abnormal left ventricular filling in early hypertension
R A Phillips1, M E Goldman, M Ardeljan
1Division of Hypertension, Mount Sinai Medical Center, New York, New York.
Insights
Over 20% of untreated individuals with early hypertension show abnormal left ventricular filling. This finding precedes left ventricular hypertrophy and is linked to age and blood pressure levels.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Borderline or mild hypertension affects a significant population.
- Early detection of cardiovascular changes is crucial for intervention.
- Left ventricular filling abnormalities can indicate early cardiac dysfunction.
Purpose of the Study:
- To determine the prevalence of abnormal left ventricular filling in untreated early hypertension.
- To identify clinical characteristics associated with abnormal left ventricular filling.
- To explore the relationship between left ventricular filling, blood pressure, and left ventricular mass.
Main Methods:
- Echocardiography and Doppler echocardiography were used to assess left ventricular structure and function.
- Ambulatory blood pressure monitoring and supine measurements were performed for precise blood pressure assessment.
- Thirty-seven untreated subjects with early hypertension (age < 50) were studied.
Main Results:
- 22% (8 of 37) of subjects exhibited abnormal left ventricular filling.
- Abnormal filling was not associated with increased left ventricular mass or heart rate.
- Abnormal left ventricular filling was best predicted by age and supine systolic blood pressure (r = 0.69).
Conclusions:
- Abnormal left ventricular filling is prevalent in over 20% of untreated early hypertension cases.
- This diastolic dysfunction precedes detectable left ventricular hypertrophy.
- Age and blood pressure levels are key predictors of abnormal left ventricular filling in early hypertension.
Abstract:
Thirty-seven untreated subjects with borderline or mild hypertension were studied to establish the prevalence and clinical characteristics associated with abnormal left ventricular filling in this disorder. Subjects were referred to this study because of casual office blood pressure measurements of greater than or equal to 140/90 mm Hg; all were less than 50 years old, had no other cardiovascular or systemic disease and had not received antihypertensive medication for at least 1 year. To precisely determine blood pressure, measurements were made over 30 min with the patient in the supine position and during awake hours with ambulatory monitoring. Left ventricular mass was determined echocardiographically, and Doppler echocardiography was used to assess left ventricular filling. No subject had increased left ventricular mass, but 8 (22%) of the 37 had abnormal left ventricular filling. All eight subjects with abnormal left ventricular filling had an ambulatory systolic blood pressure greater than 130 mm Hg and a supine systolic blood pressure greater than 122 mm Hg. Abnormal filling was not related to left ventricular mass or heart rate. In multivariate analysis, the degree of abnormal filling could best be predicted from a combination of age and supine systolic blood pressure (r = 0.69; p less than 0.001). This study suggests that in untreated early essential hypertension, abnormal left ventricular filling is present in greater than 20% of subjects, precedes detectable left ventricular hypertrophy and is related to age and prevailing level of blood pressure.