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Cardiac and arterial hypertrophy and atherosclerosis in hypertension
R B Devereux1, M J Roman, A Ganau
1Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021.
Insights
Noninvasive imaging reveals distinct patterns of heart and artery changes in hypertensive patients. These preclinical hypertensive disease patterns help predict patient risk and guide treatment strategies for better outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Traditional hypertension evaluation relies on blood pressure and basic lab tests, which have limitations in predicting patient risk.
- Current methods struggle to identify early, subclinical changes in target organs, leading to potential underestimation of cardiovascular risk.
- Preclinical hypertensive disease refers to pathological changes in the heart and arteries that precede overt symptoms.
Observation:
- Noninvasive echocardiography quantifies left ventricular mass and wall thickness, revealing patterns like concentric hypertrophy, eccentric hypertrophy, and concentric remodeling.
- Ultrasonic imaging of carotid and other arteries detects increased arterial wall thickness and atheromas.
- These cardiac and vascular changes occur in integrated patterns, suggesting a systemic adaptation to hypertension.
Findings:
- Specific patterns of cardiac adaptation (e.g., hypertrophy, remodeling) correlate with distinct hemodynamic profiles, ambulatory blood pressure, and myocardial contractility.
- Arterial wall thickness and lumen diameter in the carotid arteries parallel ventricular dimensions, indicating coordinated cardiac and vascular adaptations.
- Peripheral atherosclerosis is linked to increased ventricular mass and adverse 24-hour blood pressure profiles.
Implications:
- Noninvasive visualization of cardiac and vascular structures provides a more comprehensive assessment of hypertension pathophysiology.
- Identifying specific patterns of preclinical hypertensive disease improves risk stratification and prognosis for hypertensive individuals.
- These findings support personalized medicine approaches in managing hypertension by tailoring treatment based on identified anatomical and functional adaptations.
Abstract:
Clinical evaluation of the hypertensive patient has traditionally relied on physician measurement of blood pressure and assessment of target-organ involvement by simple laboratory tests. However, this approach is limited in its ability to identify individual patients at high or low risk of complications. In recent years, noninvasive methods have been developed to identify pathological transformations of the heart and arteries that collectively comprise "preclinical hypertensive disease." Measurements by echocardiogram or other methods of left ventricular mass and relative wall thickness identify a spectrum of cardiac adaptations to hypertension, including concentric and eccentric hypertrophy, the recently described pattern of "concentric left ventricular remodeling" (normal mass but increased relative wall thickness), and normal ventricular geometry. In clinical studies, each anatomic pattern is associated with a distinct profile of resting hemodynamics, ambulatory blood pressure, myocardial contractility, and risk of adverse outcomes. Ultrasonic imaging of the carotid or other arteries makes it possible to detect increased arterial wall thickness and discrete atheromas noninvasively. Carotid wall thickness and lumen diameter parallel similar ventricular dimensions in normotensive and hypertensive humans, indicating the presence of integrated patterns of cardiac and vascular adaptation to hypertension. Furthermore, peripheral atherosclerosis is associated with higher ventricular mass and a more adverse 24-hour blood pressure profile. In summary, noninvasive visualization of the heart and blood vessels reveals a spectrum of patterns of anatomic and functional adaptations that are related to the pathophysiology and prognosis of hypertension.