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Structural cardiac changes in relation to 24-h ambulatory blood pressure levels in borderline hypertension
C Lemne1, K Lindvall, A Georgiades
1Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
Insights
Early signs of left ventricular hypertrophy (LVH) and altered heart function are present in borderline hypertension. These cardiac changes correlate with 24-hour ambulatory blood pressure, not casual readings or insulin levels.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Imaging
Background:
- Borderline hypertension is a precursor to sustained hypertension and may be associated with early cardiac changes.
- Left ventricular hypertrophy (LVH) is a known consequence of hypertension, but its early detection in borderline cases requires further investigation.
- The role of ambulatory blood pressure monitoring (24-ABPM) and insulin levels in early LVH development needs clarification.
Purpose of the Study:
- To investigate the relationship between left ventricular hypertrophy (LVH) and 24-hour ambulatory blood pressure (24-ABPM) and insulin levels in men with borderline hypertension.
- To identify early structural and functional cardiac alterations in individuals with borderline hypertension compared to normotensive controls.
Main Methods:
- A case-control study design was employed, comparing 69 borderline hypertensive men with 69 age-matched normotensive controls.
- Echocardiography (M-mode) was used to assess LVH indices, including septal thickness and wall stress.
- 24-hour ambulatory blood pressure (24-ABPM) and insulin levels were measured in both groups.
Main Results:
- Borderline hypertensive men exhibited significantly increased septal thickness, peak systolic wall stress, and a higher septum to posterior wall thickness ratio.
- A decrease in left ventricular ejection time was observed in the borderline group, indicating altered ventricular function.
- While 24-ABPM systolic levels strongly correlated with LVH indices in borderline hypertensives, casual blood pressure and insulin levels did not show significant correlations with LVH in this group.
Conclusions:
- Asymmetric LVH and altered ventricular function are detectable in borderline hypertension.
- Early structural cardiac changes in borderline hypertension are associated with the ambulatory blood pressure profile.
- Casual blood pressure and insulin levels do not appear to be primary drivers of these early structural cardiac changes in borderline hypertension.
Objectives:
To investigate left ventricular hypertrophy (LVH) in relation to 24-h ambulatory blood pressure (24-ABPM) and insulin levels in borderline hypertension.
Design:
A case-control study.
Subjects:
Borderline hypertensive men (diastolic blood pressure (DBP) 85-94 mmHg, n = 69) and age-matched normotensive controls (DBP < or = 80 mmHg, n = 69) from a population screening programme.
Main Outcome Measures:
Echocardiography (M-mode), insulin (RIA) and 24-APBM (Del Mar P-IV) levels.
Results:
The borderline group showed a significant increase in septal thickness (10.4 +/- 1.5 vs. 9.7 +/- 1.5 mm, P < 0.01), peak systolic wall stress (218 +/- 38 vs. 202 +/- 38 10(3) dynes cm-2, P < 0.05) and a decrease in LV ejection time (28.4 +/- 2.5 vs. 29.5 +/- 2.1s, P < 0.01). The septum vs. posterior wall thickness ratio was significantly higher in the borderline group (1.13 +/- 0.14 vs. 1.06 +/- 0.14, P < 0.01). Casual BP levels did not correlate with LVH indices, while 24-ABPM systolic levels correlated strongly with LVH indices in the borderline group (r = 0.22-0.52, P < 0.05) but not in the normotensive group. Insulin levels correlates strongly with LVH indices in the normotensive group (r = 0.34-0.47, P < 0.01) but not the borderline, group.
Conclusions:
Signs of asymmetric LVH and altered ventricular function are already detectable in borderline hypertension. The data also suggest that early structural cardiac changes are related to ambulatory blood pressure profile, but not to casual blood pressure or trophic factors such as insulin.