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Racial differences in cardiac structure and function in essential hypertension
Insights
Black patients with untreated hypertension show greater left ventricular mass and impaired diastolic function compared to white patients. These cardiac differences highlight potential racial disparities in cardiovascular health.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Hypertension Research
Background:
- Untreated hypertension can lead to significant cardiac structural and functional changes.
- Racial disparities in cardiovascular disease prevalence and outcomes are well-documented.
- Understanding cardiac differences in hypertension based on race is crucial for targeted treatment.
Purpose of the Study:
- To investigate racial differences in cardiac structure and function.
- To compare previously untreated Black and White patients with hypertension.
- To identify potential disparities in left ventricular mass, thickness, and diastolic function.
Main Methods:
- Cross-sectional and Doppler echocardiography were used to assess cardiac variables.
- Untreated Black hypertensive patients were compared with age- and sex-matched White hypertensive patients.
- Patients were recruited from an outpatient cardiovascular risk factor clinic.
Main Results:
- Black patients exhibited significantly greater interventricular septal and posterior wall thickness.
- Left ventricular mass index and relative wall thickness were significantly higher in Black patients.
- Black patients showed a longer isovolumic relaxation time, indicating impaired diastolic function.
Conclusions:
- Previously untreated Black hypertensive patients have increased left ventricular mass and relative wall thickness compared to White patients.
- Black patients demonstrate more impaired left ventricular diastolic function.
- These findings suggest significant racial differences in cardiac remodeling and function in early hypertension.
Objective:
To assess racial differences in cardiac structure and function in patients presenting with previously untreated hypertension.
Design:
Untreated black patients with hypertension were compared with untreated white patients matched for age and sex. Both groups had similar body mass indices, blood pressures, and reported duration of hypertension.
Setting:
Cardiovascular risk factor clinic for outpatients.
Subjects:
36 men and 22 women with untreated essential hypertension.
Main Outcome Measures:
Variables of heart structure and function on cross sectional and Doppler echocardiography.
Results:
The black patients had a significantly greater interventricular septal thickness (mean 1.23 (95% confidence interval 1.14 to 1.33) v 1.09 (1.02 to 1.16) cm; P = 0.02) and posterior wall thickness (mean 1.14 (1.07 to 1.22) v 0.96 (0.88 to 1.03) cm; P = 0.001) than the white patients, although left ventricular internal diameter was not significantly different (mean 4.90 (4.68 to 5.12) v 4.82 (4.64 to 5.01) cm; P = 0.59). This resulted in a significantly greater left ventricular mass index (mean 151 (137 to 164) v 120 (107 to 133) g/m2; P = 0.001) and relative wall thickness (mean 0.47 (0.43 to 0.51) v 0.40 (0.37 to 0.42) cm; P = 0.004) in the black patients. Comparison of Doppler measures of left ventricular diastolic function showed a significantly longer isovolumic relaxation time in black patients (mean 107 (98 to 116) v 92 (83 to 101) ms; P = 0.02) compared with white patients, although peak early to atrial filling ratios were similar in both groups (mean 1.14 (0.95 to 1.32) v 1.04 (0.94 to 1.15); P = 0.37).
Conclusion:
Among previously untreated hypertensive patients, black subjects compared with white subjects have significantly higher left ventricular mass index and relative wall thickness, as well as more impairment of left ventricular function during diastole.