Impaired left ventricular filling in borderline hypertensive patients without cardiac structural changes

To determine the effect of borderline hypertension on left ventricular diastolic performance, 16 patients with borderline hypertension who did not have left ventricular hypertrophy and 16 age-sex-matched patients with normotension of similar age and body mass index were investigated. Pulsed Doppler echocardiography was used to record left ventricular filling signals at rest and immediately after supine ergometer exercise. All subjects had normal left ventricular structure and systolic function. At rest the borderline hypertension group in comparison with the normotension group had a depressed peak velocity of early filling (E) (44 +/- 7 vs 54 +/- 10 cm/sec; p < 0.01), no enhanced peak velocity of late filling (A) (52 +/- 8 vs 50 +/- 11 cm/sec; not significant), and a reduced E/A ratio (0.9 +/- 0.2 vs 1.1 +/- 0.3; p < 0.05). Atrial filling time and preejection period were similar in the two groups. The effect of exercise on left ventricular filling velocity in patients with borderline hypertensive resembled that in those with normotension. Percentage changes in E (+14% +/- 12% vs +14% +/- 13%) and A (+13% +/- 8% vs 11% +/- 12%) were equivalent, suggesting a preserved diastolic reserve for exercise in the borderline hypertension group. In conclusion, borderline hypertension appears to be predictive of early filling impairment, and a late filling compensative mechanism is not yet apparent. These findings in borderline hypertension without apparent cardiac damage call for clinical attention to prevent further deterioration in cardiac function.