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Effect of aging on left ventricular filling in untreated hypertensive patients
C Manca1, D Aschieri, A Piazza
1Cattedra di Cardiologia, Università di Parma, Italy.
Insights
Age significantly impacts left ventricular filling in both hypertensive and normotensive individuals. However, the aging factor appears to mask hypertension
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Left ventricular filling is crucial for cardiac function.
- Hypertension can affect diastolic function.
- The role of aging in diastolic dysfunction requires further investigation.
Purpose of the Study:
- To assess the influence of age and clinical factors on left ventricular filling.
- To compare diastolic function between hypertensive and normotensive individuals.
- To determine the independent contribution of age to left ventricular filling patterns.
Main Methods:
- Echocardiography with pulsed Doppler evaluation of left ventricular filling.
- Inclusion of 174 untreated hypertensive patients and 189 age-matched normotensive controls.
- Stepwise regression analysis to identify predictors of left ventricular filling parameters.
Main Results:
- Hypertensive individuals under 65 showed altered filling patterns (decreased peak E, increased peak A, reduced E/A ratio).
- No significant differences in filling patterns were observed between elderly hypertensive and normotensive subjects (≥65 years).
- Age was the primary independent factor influencing left ventricular filling, explaining significant variance in E/A ratio, particularly in normotensives.
Conclusions:
- Age is a major determinant of left ventricular filling, more so than hypertension in the elderly.
- The aging process may obscure the echocardiographic signs of hypertension-induced diastolic dysfunction in older adults.
- Diastolic filling patterns in the elderly are predominantly influenced by age, irrespective of hypertensive status.
Abstract:
The aim of this study was to evaluate the influence of age and other clinical and echocardiographic parameters on left ventricular filling in a group of 174 untreated patients with mild to moderate hypertension (aged 20-82 years; mean 51.2 years) and in 189 age-matched normotensive subjects. All subjects underwent an echocardiographic study with pulsed Doppler evaluation of left ventricular filling. Left ventricular dimensions and indexes of systolic function were similar and within normal limits in both groups. Left ventricular filling was altered in hypertensive subjects < 65 years with a decrease of peak early velocity (peak E), an increase of peak atrial velocity (peak A) and a reduced E/A ratio. However in subjects > or = 65 years, we did not observe any differences in transmitral flow velocity pattern between hypertensive and normotensive subjects. The stepwise regression analysis showed that age alone explains up to 8% of peak E variance, 14% of peak A and 26% of E/A ratio in hypertensives, while in normotensives it explains up to 18% of peak E variance, 50% of peak A and 61% of E/A ratio. The other variables entered into the regression slightly improved the predictive power. In conclusion, age is the major independent factor affecting left ventricular filling in both groups, even if its predictive power was smaller in the hypertensive group. The similarity of diastolic filling pattern in elderly hypertensive and normotensive subjects suggests that the 'aging factor' plays an important role in influencing left ventricular filling pattern so as to mask the effect of hypertension in the elderly patients.