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[Structural and functional changes in the heart of the hypertensive patient. An echocardiographic study]
J F Guadalajara Boo1, O Galván Montiel, P Camacho
1Instituto Nacional de Cardiología Ignacio Chávez.
Insights
Essential hypertension (EH) patients exhibit elevated blood pressure (BP) and left ventricular hypertrophy (LVH) without impaired systolic function. However, sustained pressure overload can lead to heart disease.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Physiology
Background:
- Essential hypertension (EH) is a significant cardiovascular risk factor.
- Understanding the cardiac adaptations to chronic pressure overload is crucial for preventing hypertensive heart disease.
- Ambulatory blood pressure monitoring (ABPM) and echocardiography are key diagnostic tools.
Purpose of the Study:
- To compare blood pressure (BP) and cardiac parameters in patients with essential hypertension (EH) versus healthy individuals (HP).
- To investigate the adaptive mechanisms of the left ventricle (LV) in response to sustained pressure overload.
- To elucidate the progression from adaptive left ventricular hypertrophy (LVH) to pathological hypertensive heart disease.
Main Methods:
- Utilized ambulatory blood pressure monitoring (ABPM) to assess 24-hour BP patterns in 15 EH patients and compare with 31 healthy people (HP).
- Conducted 2-D echocardiograms on HP and EH patients to evaluate ventricular performance parameters.
- Compared echocardiographic findings between the EH and HP groups.
Main Results:
- EH patients demonstrated significantly higher BP levels than HP, with a loss of the normal circadian BP rhythm.
- EH patients exhibited left ventricular hypertrophy (LVH) but maintained normal systolic ventricular function (VF).
- Systolic wall stress was found to be low due to inappropriate LVH, suggesting an adaptive mechanism to preserve VF despite pressure overload.
Conclusions:
- Early-stage essential hypertension is characterized by adaptive left ventricular hypertrophy that preserves systolic function.
- Sustained pressure overload can transform adaptive LVH into pathological remodeling, involving interstitial collagen deposition.
- Advanced stages of this process lead to diastolic dysfunction, myocardial ischemia, arrhythmias, and potentially fatal heart failure, defining true hypertensive heart disease.
Abstract:
We studied 15 patients with essential hypertension (EH) in whom the diagnosis was corroborated with ambulatory blood pressure monitoring (ABPM). The blood pressure levels (BP) were compared with values obtained from healthy people (HP). We studied 31 HP with 2-D echocardiogram and the parameters of ventricular performance were compared with the values obtained from EH people. ABPM shown that the EH people has higher BP values than HP around 24 hs (EH loss the circadian rhythm of BP). On the other hand the EH had left ventricular hypertrophy (LVH) with normal systolic ventricular function (VF). The systolic wall stress was low because the LVH was inappropriate. The LVH as adaptative mechanism maintains normal the VF in spite of pressure overload without increasing MVO2. When the pressure overload is not eradicated in a variable amount of time the adaptative mechanisms slowly change to a pathologic process caused by collagen deposition in the interstitium of the heart. In advanced stages the remodeling process causes diastolic disfunction, myocardial ischemia, arrhythmias and death by heart failure or suddenly. This last stage is the real hypertensive heart disease.