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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.
American Journal of Hypertension
|April 2, 1998
Summary
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.