[Intracardiac hemodynamics and clinico-pathogenetic variants of the course of hypertension]

In 187 patients with different stages of hypertensive disease, besides studying the calculated values of systemic hemodynamics (minute volume, total peripheral vascular resistance), echocardiography was used to study values characterizing the state of intracardiac hemodynamics: end-diastolic (Vd), end-systolic (Vs), and stroke (Ve) volumes, the ejection fraction (EF), and the left ventricular myocardium mass (MM). According to the value of the minute volume (MV) and the total peripheral vascular resistance (TPVR), the patients were divided into 2 main groups--with hypo- or hyperdynamic type of circulation. In accordance with the values of intracardiac hemodynamics, 2 subgroups were conditionally distinguished among the patients with hyperdynamic-type circulation: the first subgroup was composed of patients with comparatively low Vd, Vs, and Ve values and moderate increase in MM, the second subgroup of those with high Vd, Vs, Ve, and MM values. It is shown that with gradual progression of hypertensive disease the number of patients in the second subgroup increases and the number of those in the second subgroup decreases, respectively. Parallel study of the functional state of the sympatheticoadrenal and renin-angiotensin systems showed their activity to be higher in patients of the first subgroup with hyperdynamic type of circulation. Comparatively new hemodynamic aspects of hypertensive disease connected with the contribution of the heart itself to the pathogenesis of the disease are discussed. It is suggested that among patients with hypertensive disease there are individuals with predominant and early involvement of the heart in the pathological process with rapid development of left ventricular hypertrophy.