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Prevalence and distribution of left ventricular diastolic dysfunction in treated patients with long-lasting
Ewa Świerblewska1, Jacek Wolf1, Katarzyna Kunicka1
1a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland.
Insights
Sub-clinical left ventricular diastolic dysfunction (LVDD) is common in treated hypertensive patients. Factors like female sex, age, obesity, diabetes, and higher blood pressure increase LVDD risk, while blood pressure treatment may reduce it.
Area of Science:
- Cardiology
- Hypertension Research
- Diastolic Function Assessment
Background:
- Sub-clinical left ventricular diastolic dysfunction (LVDD) is a known cardiovascular risk factor.
- Current guidelines do not classify LVDD as target organ damage in hypertension.
- The relationship between hypertension and LVDD is complex due to co-existing risk factors.
Purpose of the Study:
- To evaluate the prevalence and severity of diastolic dysfunction in treated hypertensive patients.
- To identify predictors of LVDD in this population.
- To assess the impact of hypertension management on LVDD.
Main Methods:
- Retrospective analysis of 610 treated hypertensive patients from the CARE NORTH Study.
- Exclusion of patients with overt cardiovascular disease, heart failure, or other specific conditions.
- Staging of LVDD using comprehensive transthoracic echocardiography.
Main Results:
- Nearly 50% of patients exhibited normal diastolic function.
- Grade 1 LVDD was found in 24.4% and Grade 2 LVDD in 19.3% of patients.
- Independent predictors of LVDD included female sex, older age, obesity, diabetes, higher SBP, and increased LVMI; blood-lowering therapy was protective.
Conclusions:
- There is a high prevalence of diastolic dysfunction in treated hypertensive patients without overt cardiovascular disease.
- LVDD should be considered in the risk assessment of hypertensive individuals.
- Further research is needed to integrate LVDD assessment into hypertension guidelines.
Background:
Although the presence of sub-clinical left ventricular diastolic dysfunction (LVDD) increases cardiovascular risk, the current ESH/ESC guidelines do not include the presence of this condition in the list of target organ damage or cardiovascular risk charts dedicated to the hypertensive population. Several conditions may predict the LVDD occurrence, however, clustering of these factors with hypertension makes the relationship less clear. Therefore, the aim of this study was to evaluate both the occurrence and the severity of diastolic dysfunction in a large cohort of treated hypertensives.
Methods:
We retrospectively analyzed records of 610 hypertensive participants of the CARE NORTH Study who consented to echocardiography and were free of overt cardiovascular disease. Mean age was 54.0 ± 13.9 years (mean ± SD), BMI 29.7 ± 4.8 kg/m2. The exclusion criteria were: established heart failure, LVEF <45%, coronary revascularization, valvular defect, atrial fibrillation, or stroke. The staging of LVDD was based on comprehensive transthoracic echocardiographic measurements.
Results:
49.7% percent of the patients had normal diastolic function (38.8% vs. 59.0%, females (F) vs. males (M), respectively; p < .001). Grade 1 LVDD was documented in 24.4% (27.8% and 21.6%; F and M; p = .08) and grade 2 LVDD in 19.3% (24.9% and 14.6%; F and M; p = .001) of the patients. None were diagnosed with grade 3 LVDD. In the logistic regression model, female sex, advancing age, obesity status, established diabetes mellitus, higher 24-hour SBP, and increasing LVMI were identified as the independent variables increasing the odds for the presence of LVDD, whereas blood-lowering therapy attenuated the risk.
Conclusions:
There is an unexpectedly high prevalence of different forms of diastolic dysfunction in treated hypertensive patients who are free of overt cardiovascular disease.
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