Blood pressure related echocardiographic changes in adolescents and young adults

In 1973, standardized blood pressure measurements were obtained in 837 high school students in Bourbon County, Kentucky, a rural county with a high prevalence of individuals with systemic hypertension. In 1978, follow-up measurements of blood pressure were performed in selected individuals who were in the high, intermediate, and low ranges of the initial sex-specific blood pressure distributions. Relative rank order of initial blood pressure measurements over the five-year period was maintained. The results of this population-based study provided an opportunity to evaluate the cardiac status in young adults with relatively high blood pressures maintained over five years. Standard m-mode echocardiographic examinations were, therefore, performed over five years. Standard m-mode echocardiographic examinations were, therefore, performed at the time of follow-up. In individuals in the low and intermediate ranges for systolic blood pressure, indices of ventricular hypertrophy were directly correlated with blood pressure level. Among individuals with higher values for systolic blood pressure, after adjusting for the effects of relative body size, indices of ventricular hypertrophy were not significantly different from those noted in the intermediate group. Indices of cardiac performance and estimated left ventricular systolic wall stress were, however, significantly elevated in this "high" blood pressure group. Early in the course of systemic hypertension increased wall stress, rather than hypertrophy, appears to be the primary cardiac manifestation of elevated systolic blood pressure.