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Vascular changes in hypertensive patients with different left ventricular geometry
S D Pierdomenico1, D Lapenna, M D Guglielmi
1Hypertension Study and Treatment Center, Institute of Pathophysiology, G. D'Annunzio University, Chieti, Italy.
Insights
Hypertension alters blood vessels, with concentric left ventricular changes leading to thicker artery walls and increased resistance. These vascular changes may stem from hemodynamic forces and growth factor activity.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- Hypertension is linked to structural changes in the heart's left ventricle.
- Different patterns of left ventricular geometry may influence vascular adaptations.
Purpose of the Study:
- To investigate vascular structural changes in hypertensive patients with varying left ventricular geometries.
- To assess intimal-medial thickness and forearm vascular resistance in relation to left ventricular remodeling and hypertrophy.
Main Methods:
- Evaluated 250 untreated hypertensive patients using ambulatory blood pressure monitoring and echocardiography.
- Selected four matched groups based on left ventricular geometry: normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy.
- Utilized carotid ultrasonography for intimal-medial thickness and lumen diameter, and venous occlusion plethysmography for forearm vascular resistance.
Main Results:
- Significantly higher intimal-medial thickness and forearm vascular resistance were observed in patients with concentric left ventricular remodeling and hypertrophy compared to eccentric hypertrophy and normal geometry.
- No significant difference in vascular measures between concentric remodeling and concentric hypertrophy groups.
- A trend towards increased vascular measures was noted in eccentric hypertrophy versus normal geometry, but without statistical significance.
Conclusions:
- Cardiac adaptation patterns in hypertension are associated with corresponding vascular adaptation spectrums.
- These vascular changes may be influenced by hemodynamic stimuli and variations in vascular growth factor expression or activity.
Objective:
To evaluate vascular structural changes in hypertensive patients with different patterns of left ventricular geometry.
Design And Methods:
From 250 untreated hypertensive patients who underwent ambulatory blood pressure monitoring and echocardiographic study, we selected four groups matched for sex, age, body mass index, smoking habits and serum lipid values: 25 hypertensive subjects with normal left ventricular geometry, 16 with concentric left ventricular remodeling, 26 with concentric left ventricular hypertrophy and 18 with eccentric non-dilated left ventricular hypertrophy. These patients underwent carotid ultrasonography to evaluate the intimal-medial thickness and lumen diameter, and venous occlusion plethysmography to record minimum forearm vascular resistance (an index of arteriolar structural changes).
Results:
The intimal-medial thickness and minimum forearm vascular resistance were significantly higher (both P<0.05) in hypertensive subjects with concentric left ventricular remodeling (0.95 mm, 2.68 RU) and concentric left ventricular hypertrophy (0.96 mm, 2.71 RU) than in those with eccentric non-dilated left ventricular hypertrophy (0.81 mm, 2.36 RU) and normal left ventricular geometry (0.71 mm, 2.15 RU). There was no difference between hypertensive patients with concentric left ventricular remodeling and concentric left ventricular hypertrophy. The intimal-medial thickness and minimum forearm vascular resistance tended to be higher in hypertensive subjects with eccentric non-dilated left ventricular hypertrophy than in those with normal left ventricular geometry, but this difference did not attain statistical significance.
Conclusions:
This study shows that the spectrum of cardiac adaptation to hypertension is associated with a spectrum of vascular adaptation which might be related both to hemodynamic stimuli and differences in the expression or activity of vascular growth factors.