There is a lack of detailed data regarding the effect of exercise training in pharmacologically treated hypertensive patients. Therefore, the aim of this study was to evaluate the effects of exercise training on left and right ventricular morphologic and functional parameters by means of conventional echocardiography and sensitive new echocardiographic techniques including tissue Doppler velocity and strain imaging, that were performed in pharmacologically treated hypertensive patients at baseline and at the end of a specific exercise training protocol for primary prevention of cardiovascular disease. We selected 116 pharmacologically treated hypertensive patients who completed the exercise training protocol. All patients underwent a clinical history and examination; transthoracic echocardiography and exercise testing were performed at baseline and at the end of the exercise training protocol. Conventional echocardiography revealed a mild degree of diastolic dysfunction without significant differences or variations from baseline to the end of the exercise training protocol. In contrast, tissue Doppler velocity and strain imaging measurements demonstrated and highlighted the positive influence of exercise training: for both left and right ventricle myocardial early peak diastolic velocities (Em), the ratio of myocardial early-late peak diastolic velocity (Em/Am), myocardial peak systolic velocities (Sm) and peak strain and strain rate values significantly increased at the end of the exercise training protocol, suggesting a relationship between exercise capacity and both left and right ventricular systo-diastolic function. Our study, by means of newer more sensitive echocardiographic techniques, clearly demonstrated the positive impact of exercise training on both left and right ventricular systo-diastolic function, in terms of adjunctive subclinical improvement, in pharmacologically treated hypertensive patients.

Very few data exist regarding the effect of obesity on both left and right systo-diastolic ventricular function in hypertensive patients. Therefore, the aim of this study was to determine the existence and extent of an obesity-related adjunctive depressive effect on left-and right-ventricular systo-diastolic dysfunction. This study compared non-obese with obese hypertensive patients and evaluated left-and right-ventricular morphological and functional parameters by means of conventional echocardiography and by two new sensitive echocardiographic techniques: tissue Doppler velocity and strain imaging. We selected 248 hypertensive patients and divided them into four groups according to increasing body mass index (BMI). All patients underwent a clinical history and examination and transthoracic echocardiography, including conventional echocardiographic evaluation and tissue Doppler velocity and strain imaging measurements. Conventional echocardiographic evaluation did not reveal an association between ventricular systo-diastolic dysfunction and increasing BMI. In contrast, tissue Doppler velocity and strain imaging measurements emphasized the negative influence of obesity. For measurements in both the left and right ventricle, myocardial early peak diastolic velocities (E m ), the ratio of myocardial early-to-late peak diastolic velocity (E m /A m ), myocardial peak systolic velocities (S m ), and peak strain and strain rate values significantly decreased with increasing BMI (Po0.01 for all parameters measured), even after adjusting for potential confounding variables. In conclusion, by means of new more sensitive echocardiographic techniques, our study clearly demonstrated the negative impact of obesity on both left-and right-ventricular systo-diastolic function, in terms of adjunctive sub-clinical worsening, in hypertensive patients.

Introduction. Obesity is an independent risk factor for the development of heart failure, even after accounting for other co-morbid conditions that cluster with it, such as above all hypertension. In this context, application of innovative echocardiographic techniques like tissue Doppler imaging (TDI) and strain imaging (SI) has been largely extended, in order to improve the assessment of systodiastolic ventricular function. Aim. To evaluate left ventricular morphologic and functional parameters with traditional echocardiography, TDI and SI in patients with hypertension compared to patients with hypertension and obesity. Methods. We evaluated 190 patients, mean age 56±11 years, 94 males, affected by treated essential hypertension and divided according to their body mass index (BMI) in Group 1 (BMI <30, n=96 hypertensive patients without obesity) and Group 2 (BMI ≥30, n=94 hypertensive patients with obesity). The 2 groups were matched in age, sex, heart rate, systo-diastolic blood pressure, antihypertensive drug therapy; apart from familiar history of cardiovascular disease, no other risk factors nor systemic diseases were represented in the study population. All patients were evaluated with traditional echocardiography, TDI and SI: for all patients mean values of peak systolic, early diastolic and late diastolic velocities of the septal, lateral, inferior and anterior region of the mitral annulus were calculated; peak strain values of basal interventricular septum were also obtained. Results. BMI was 26.9±4.6 in Group 1 and 35.7±5.2 in Group 2 (p<0.001). Traditional echocardiographic parameters showed no significant differences between the 2 groups, with the only exception of left ventricular mass; however, left ventricular mass index was similar in both groups. About TDI parameters, mean values of peak systolic and early diastolic velocities were significantly decreased in Group 2 (respectively 5.55±.4 cm/s vs. 6.46 ±1.3 cm/s, p<0.01; 5.69 ±1.5 cm/s vs. 6.42±1.4 cm/s, p<0.05); mean values of peak late diastolic velocities were increased without reaching statistical significance in Group 2 (7.2 4±1.9 cm/s vs. 6.80 ±2.3 cm/s, p=0.08). About SI parameters, peak strain values of basal interventricular septum were also significantly decreased in Group 2 (18.24±3.2 vs. 21.1 2±2.9, p<0.01). Conclusions. In hypertensive patients obesity is related to a higher level of systo-diastolic left ventricular dysfunction. In our study, TDI and SI revealed and highlighted that even if obesity tends to cluster with hypertension, its presence is related to a significant worsening of the left ventricular dysfunction observed in hypertensive patients.

Introduction. New echocardiographic techniques, such as tissue Doppler imaging (TDI) and strain imaging (SI) have improved the assessment of systo-diastolic ventricular function in terms of accuracy and precision. A very interesting issue should be to examine, by means of these innovative echocardiographic tools, if exercise training could be able to improve the pattern of early mild systo-diastolic dysfunction frequently characterizing hypertensive patients. Aim. To evaluate left ventricular morphologic and functional parameters with traditional echocardiography, TDI and SI in patients with hypertension at baseline and at the end of a specific exercise training program for primary prevention of cardiovascular disease (CVD). Methods. We evaluated 84 patients, mean age 58±10 years, 49 males, with treated hypertension who underwent a specific exercise training program, consisting in three exercise training sessions a week with endurance protocol on a treadmill or a cycle ergometer. Systolic and diastolic blood pressure, heart rate and antihypertensive drug therapy were stable in the last 3 months; apart from familiar history of CVD, no other risk factors nor systemic diseases were represented in the study population. All patients were evaluated at baseline and at the end of the training program with traditional echocardiography, TDI and SI: for all patients, mean values of peak systolic, early diastolic and late diastolic velocities of the septal, lateral, inferior and anterior region of the mitral annulus were calculated; peak strain values of basal interventricular septum were also obtained. Results. Main characteristics of the study population, antihypertensive drug therapy and traditional echocardiographic parameters showed no significant variations from baseline to the end of the program. About TDI parameters, mean values of peak systolic velocities were significantly increased (6.1 4±1.5 cm/s baseline, 7.13 ±1.8 cm/s end, p<0.01); mean values of peak early diastolic velocities were also significantly increased (6.0 8±1.6 cm/s baseline, 6.75 ±1.7 cm/s end, p<0.05); mean values of peak late diastolic velocities showed a trend to a decrease with out reaching statistical significance (6.8 8±1.7 cm/s baseline, 6.48 ±2.0 cm/s end, p=0.06). About SI measures, peak strain values of basal interventricular septum were significantly increased (20.7 8±3.6 baseline, 24.56 ±3.9 end, p<0.01). Conclusions. In our study, even if traditional echocardiography showed no significant differences, the positive effect of exercise training on left ventricular dysfunction in hypertensive patients (primary prevention) is demonstrated and emphasized by both TDI and SI.