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Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension.
P Palatini1, P Visentin, P Mormino
1HARVEST Study Group, Padova, Italy.
Insights
Hypertension causes early changes in left ventricular (LV) anatomy, not diastolic dysfunction. These structural changes in the heart precede impaired LV filling in early hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Diastolic dysfunction was previously thought to be the earliest cardiac sign of hypertension.
- Left ventricular (LV) structural abnormalities may develop later in hypertensive cardiac disease.
Purpose of the Study:
- To investigate early cardiac changes in stage I hypertension.
- To determine if diastolic dysfunction or LV structural changes manifest first.
Main Methods:
- M-mode and Doppler echocardiography were used to study 722 hypertensive subjects (18-45 years old) and 95 controls.
- 24-hour ambulatory blood pressure monitoring was performed.
- Multiple regression analyses assessed predictors of cardiac changes.
Main Results:
- Hypertensive subjects showed modest increases in LV mass index (+10.4 g/m2), LV wall thickness (+1.8 mm), and relative wall thickness (+0.032) compared to controls.
- A slight increase in atrial filling peak velocity was noted, but LV diastolic filling ratios did not differ.
- 24-hour mean blood pressure significantly predicted LV mass index and wall thickness in hypertensive individuals.
Conclusions:
- Changes in left ventricular (LV) anatomy are the earliest indicators of cardiac involvement in hypertension.
- Left ventricular filling is only marginally affected in the initial stages of hypertension.
Abstract:
It has been claimed that diastolic dysfunction is the earliest cardiac abnormality in hypertension, preceding the development of left ventricular (LV) structural abnormalities. To detect early signs of hypertensive cardiac involvement 722 subjects (533 men and 189 women), 18-45 years old, with stage I hypertension, were studied by M-mode and Doppler echocardiography. Blood pressure was measured by 24-h ambulatory monitoring. Ninety-five normotensive individuals of similar age and gender distributions were studied as controls. Significant, though modest, changes of LV mass and geometry were found in the participants in comparison with the normotensive controls. The increment was +10.4 g/m2 for LV mass index, +1.8 mm for LV wall thickness, and +0.032 for relative wall thickness. A slight increase in atrial filling peak velocity was found in the hypertensive subjects at Doppler analysis of transmitral flow, but the ratio of early to atrial velocity of LV diastolic filling did not differ between the two groups. In multiple regression analyses, which included age, body mass index, heart rate, smoking, and physical activity, 24-h mean blood pressure emerged as a significant predictor of LV mass index (men, P = .003; women, P = .04) and wall thickness (men, P = .03; women, P = .004) in the hypertensive subjects, whereas no index of diastolic filling was significantly associated with ambulatory blood pressure in either gender. The present data indicate that changes in LV anatomy are the earliest signs of hypertensive cardiac involvement. Left ventricular filling is affected only marginally in the initial phase of hypertension.