Left Ventricular Structural Abnormalities Signal Cardiac Change In Hypertension

The earliest signs of cardiac involvement in hypertension are left ventricular structural abnormalities.

Left ventricular diastolic function is only marginally affected, even when multiple parameters of left ventricular filling are taken into account, say investigators based at the University of Padova, Italy. This finding may help to resolve the controversy among cardiologists over whether abnormalities in diastolic function are an early warning of cardiac change in hypertension.

The investigators performed echocardiographic Doppler examination and ambulatory blood pressure monitoring in 578 young patients with stage I hypertension from the Hypertension and Ambulatory Recording Venetia Study (HARVEST) and 101 normotensive controls.

Left ventricular mass, wall thickness and relative wall thickness, adjusted for confounders, were all significantly greater in the hypertensive patients.

Likewise, after adjustment for confounders, A-wave peak velocity, A-wave velocity time integral, total area and E-wave peak velocity were all significantly higher in the hypertensives.

All indices of diastolic function were similar in the hypertensive subjects subdivided according to whether they had ‘white-coat’ or sustained hypertension.

Among the hypertensives, age and heart rate were the strongest predictors of diastolic indices. On the other hand, ambulatory blood pressure explained only a small part of the E/A ratio, A-wave peak velocity and the first one third total area ratio.

Left ventricular mass and wall thickness were not associated with any Doppler index.

A clustering of diastolic indices (E/A wave ratio, deceleration time, first one third of diastole and peak E-wave-velocity) to identify subjects with diastolic dysfunction, disclosed no significant differences in either clinical or ambulatory blood pressure between patients with diastolic dysfunction and those with normal function.

American Heart Journal 2001;142(6):1016-1023