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Primary hypertension: left ventricular mass and function, sympathetic nervous system activity, and therapy
V DeQuattro1, D D Lee, I K Shkhvatsabaya
1Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
Insights
Neural tone links to blood pressure and left ventricular mass in hypertension. Elevated norepinephrine may indicate early diastolic dysfunction, suggesting neural tone
Area of Science:
- Cardiology
- Hypertension Research
- Neurocardiology
Background:
- Left ventricular (LV) mass predicts morbidity in hypertensive patients.
- Left ventricular hypertrophy (LVH) mechanisms in primary hypertension require elucidation.
- Sympathetic nervous system (SNS) activity is implicated in cardiovascular disease.
Purpose of the Study:
- To investigate the relationships between LV mass, arterial blood pressure, and plasma norepinephrine levels.
- To explore the role of neural tone in the pathogenesis and sequelae of hypertension.
- To understand how norepinephrine relates to LVH and diastolic function.
Main Methods:
- Examined three populations of patients with mild or moderate hypertension.
- Assessed LV mass, arterial blood pressure, and plasma norepinephrine.
- Analyzed the correlations between these parameters.
Main Results:
- Found a link between neural tone and arterial blood pressure in both mild and moderate hypertension.
- Observed a correlation between neural tone and LV mass in moderate hypertension.
- Identified a relationship between neural tone and diastolic function in mild hypertension.
- Elevated norepinephrine may precede manifest hypertrophy, suggesting early diastolic dysfunction.
Conclusions:
- Neural tone is a significant factor in both the development and consequences of hypertension.
- Norepinephrine levels can serve as an early indicator of diastolic dysfunction.
- Therapeutic interventions, including drug and non-drug treatments, can reduce LV mass post-blood pressure reduction, with varying impacts on neural tone.
Abstract:
Left ventricular (LV) mass is a predictor of morbidity in patients with hypertension. To elucidate the mechanisms of left ventricular hypertrophy (LVH) in primary hypertension, we examined the relationships of LV mass, arterial blood pressure, and plasma norepinephrine--as a marker of sympathetic nervous system tone--in three populations of patients with mild or moderate hypertension. We found linking of neural tone with (a) arterial blood pressure in mild and moderate hypertension, (b) LV mass in moderate hypertension, and (c) diastolic function in mild hypertension, suggesting that neural tone is a factor in both the pathogenesis and the sequelae of hypertension. Additionally, elevated norepinephrine level may reflect subtle loss of diastolic function before hypertrophy is manifest. Both nondrug and drug therapy may regress LV mass after blood pressure reduction with disparate effects on neural tone.