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Cardiac function and dysfunction in hypertension
1Department of Cardiovascular Biology, Cleveland Clinic Foundation, OH 44195.
Insights
Hypertension impacts cardiac function, affecting cardiac output and left ventricular filling. Monitoring both systolic and diastolic function is crucial for managing hypertension and guiding therapy.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Internal Medicine
Background:
- Hypertension is a prevalent condition increasing left ventricular afterload.
- It significantly impacts cardiovascular system function.
Purpose of the Study:
- To review the effects of elevated blood pressure on cardiac function.
- To understand the cardiac implications of hypertension.
Main Methods:
- Literature review on hypertension and cardiac function.
- Analysis of studies assessing cardiac output, ventricular function, and compliance.
Main Results:
- Early hypertension may increase cardiac output with normal volume.
- Established hypertension often shows normal resting systolic function but reduced filling rates in some patients.
- Left ventricular hypertrophy in hypertension is linked to high morbidity, reduced compliance, and altered adrenergic response.
Conclusions:
- Assessing both systolic and diastolic cardiac function is vital for hypertensive patients.
- Monitoring cardiac function aids in therapy selection and patient management.
Background:
Hypertension is the most common condition of increased left ventricular afterload that affects the cardiovascular system.
Objective:
To review the effects of increased blood pressure on cardiac function.
Summary:
In early or borderline hypertension, cardiac output increases but intravascular volume remains normal. In uncomplicated established hypertension, left ventricular systolic function is generally normal at rest; however, the left ventricular filling rate is reduced in approximately 30% of hypertensive patients without associated alterations in systolic function. In the presence of left ventricular hypertrophy, overall left ventricular systolic performance remains within normal limits; however, left hypertrophy in hypertension is associated with a high morbidity rate, possibly due to increased collagen concentration leading to reduced left ventricular compliance, fewer adrenergic receptors, reduced responsiveness of the adenylate cyclase system, and reduced coronary flow reserve. Acute increases in blood pressure in a hypertensive patient may worsen cardiac function, particularly in the presence of medications that interfere with the adrenergic support of the heart. New, accurate, noninvasive techniques can assess cardiac structural and functional aspects of hypertension under precise circumstances.
Conclusions:
Assessing both systolic and diastolic function is important in the follow-up of hypertensive patients and in the choice of therapy.