Asymmetric ventricular hypertrophy in patients with essential hypertension

We attempted to clarify the pathogenesis of asymmetric ventricular hypertrophy in hypertensive patients, especially regarding sympathetic nervous system and renin-angiotensin system. Subjects were divided in 3 groups by echocardiographic findings; 1) 15 patients with non-hypertrophy (NH), 2) 14 patients with symmetric hypertrophy (SH), and 3) 10 patients with asymmetric hypertrophy (ASH). Subjects with ASH showed following features. Age (53.7 +/- 1.6 yr) was older than NH (43.7 +/- 1.4 yr) but not different from SH (49.7 +/- 2.3 yr). Mean arterial pressure (119.0 +/- 3.9 mmHg) was higher than NH (107.5 +/- 1.4 mmHg) but not different from SH (122.4 +/- 2.8 mmHg). End-diastolic and end-systolic dimensions were smaller and ejection fraction was larger than those of NH and SH. Cardiac index (3.90 +/- 0.37 L/min/M2) was largest among 3 groups. UNE (19.5 +/- 2.5 micrograms/day) was lower than SH (31.2 +/- 2.5 micrograms/day). PRA (0.44 +/- 0.16 ng/ml/h) was lower than SH (1.53 +/- 0.20 ng/ml/h) and NH (1.62 +/- 0.28 ng/ml/h). Ejection fraction was correlated with UNE (r = 0.835) and PRA (r = 0.736). We suggest that the heart of hypertensives with ASH is in hyperdynamic state due to the hyperresponsiveness to sympathetic stimuli, although they have a decrease of sympathetic nervous activity, and the renin-volume axis may have no important role on the pathogenesis of ASH.