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Left ventricular hypertrophy and arterial hypertrophy
J M Mallion1, J P Baguet, J P Siché
1CHU de Grenoble, France.
Insights
Hypertension (HT) classification involves blood pressure and organ damage. Cardiac and vascular changes, like left ventricular hypertrophy (LVH) and intima-media thickening (IMT), are linked in hypertensive patients.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- The 1996 WHO recommendations emphasize blood pressure and target organ lesions for hypertension (HT) classification.
- Cardiac and vascular function, particularly hypertrophy and remodeling, are crucial in understanding HT.
- Limited research exists on the prevalence and correlation of cardiac and vascular changes.
Purpose of the Study:
- To investigate the association between cardiac and vascular remodeling in hypertension.
- To differentiate between compliance and resistance vessels in relation to cardiac changes.
- To explore the diagnostic, prognostic, and therapeutic implications of these associations.
Main Methods:
- Distinguishing between compliance vessels (e.g., carotid artery) and resistance vessels (e.g., radial artery).
- Assessing prevalence of cardiac and vascular hypertrophy in normotensive and hypertensive subjects.
- Examining intima-media thickness (IMT) and left ventricular hypertrophy (LVH) patterns.
- Correlating radial artery parameters with cardiac measurements like left ventricular wall thickness and carotid artery distensibility.
Main Results:
- Prevalence of cardiac and vascular hypertrophy is similar in compliance vessels (approx. 5% normotensive, 12% hypertensive).
- Intima-media thickening (IMT) is more pronounced in subjects with left ventricular hypertrophy (LVH).
- Concentric left ventricular remodeling without LVH is linked to increased IMT; LVH shows similar IMT severity, especially concentric types.
- Significant correlations found between left ventricular wall thickness and carotid artery compliance, and between radial artery lumen ratio and relative wall thickness (though the latter is age/BP dependent).
Conclusions:
- Cardiac and vascular structural changes, including LVH and IMT, are associated in hypertension.
- Compliance vessels show similar hypertrophy prevalence in hypertensive individuals.
- Further research is needed to confirm these associations and understand contributing factors (hemodynamic, hormonal, genetic) for diagnostic, prognostic, and therapeutic advancements.
Abstract:
In the most recent WHO recommendations of 1996 it was reiterated that the classification of HT still remains based on the actual BP figures but also on the importance of target organ lesions. Thus the study of cardiac and vascular function and in particular the presence of hypertrophy or remodeling is of importance. A limited number of studies have examined the prevalence, the association and the correlation between modifications and remodeling in the heart and in the vasculature. It is important to distinguish compliance vessels such as the carotid from resistance vessels such as the radial. For compliance vessels the prevalence of cardiac and vascular hypertrophy are nearly identical being around 5% for normotensive subjects and around 12% for hypertensive subjects. This prevalence of thickening in the intima-media is more evident in subjects with left ventricular hypertrophy (LVH). The left ventricular geometric pattern is also an element to take into account. The presence of concentric remodeling of the left ventricle without LVH has already been associated with an increase in intima-media thickness (IMT). When there is an LVH this IMT is similar in severity to the LVH and in particular concentric. For resistance vessels such as the radial artery the number of studies is limited but a significant correlation between left ventricular mean wall thickness and common carotid artery distensibility and compliance has been found. There is also a significant correlation between the radial median lumen ratio and the relative wall thickness but this correlation disappears when age and systolic BP are taken into account. Thus for this type of vessel it is too early to conclude the elements contributing to structural changes. The determinant factors for these structural changes in the heart and the carotid arteries associated with hypertension are certainly multiple be they haemodynamic, hormonal or genetic. The observation establishing an association between anomalies at cardiac and vascular level may have undoubted diagnostic, prognostic and therapeutic implications which are all intimately related and which require refinement and confirmation.