D iastolic heart failure is a frequent complication of hypertension 1 and is preceded by changes in left ventricular (LV) filling characteristics that reflect decreased compliance of the ventricular wall. In hypertension, changes in LV diastolic function occur even in the absence of ventricular hypertrophy and are associated with increased morbidity and mortality. 2 Therefore, early identification of hypertension-related LV filling changes is important to forestall subsequent cardiac deterioration leading to diastolic heart failure. 3 Sensitivity of conventional echocardiography in detection of early changes in LV filling properties is limited, 4 whereas pulsed tissueDoppler imaging (TDI) with measurement of myocardial velocities at several segments of the LV wall allows more sensitive and reproducible 5 detection of LV diastolic impairment.Many factors beyond the blood pressure-related cardiac workload could contribute to the development of diastolic abnormalities of the hypertensive heart. These factors include ageing, 6 obesity, 7 hyperglycemia with insulin resistance, 8 and a prothrombotic state. 9 Moreover, dietary factors such as caloric, 10 electrolyte, 11 and ethanol intake 12 might affect LV diastolic properties. Chronic alcoholic subjects are at risk for the development of nonischemic dilated cardiomyopathy and heavy ethanol consumption (>90 g/d of ethanol; ≈7-8 standard drinks per day) is associated with impairment of LV systolic function. Animal studies have demonstrated that longterm ethanol exposure produces a variety of tissue and cellular changes. These changes can impair cardiomyocyte function leading to heart failure and include either necrosis or apoptosis of myocytes, mitochondrial and sarcoplasmic reticulum dysfunction, changes in isoforms of myofilament proteins, and defective intracellular calcium transport. 13 Previous studies conducted with conventional echocardiography indicated that, in addition to the well-known untoward effects on LV systolic function, LV filling properties are impaired in chronic asymptomatic alcoholics. 14,15 However, information on the association of moderate (≤14 Abstract-Ethanol consumption is associated with left ventricular dysfunction in heavy ethanol drinkers. The effect of moderate ethanol intake on left ventricular function in hypertension, however, is unknown. We investigated the relationship between ethanol consumption and cardiac changes in nonalcoholic hypertensive patients. In 335 patients with primary hypertension, we assessed daily ethanol consumption by questionnaires that combined evaluation of recent and lifetime ethanol exposure and examined cardiac structure and function by echocardiography. Patients with abnormal liver tests, previous cardiovascular events, left ventricular ejection fraction <50%, and creatinine clearance <30 mL/min 1.72 m 2 were excluded. Left ventricular hypertrophy was found in 21% of hypertensive patients and diastolic dysfunction was detected in 50% by tissue-Doppler imaging. Ethanol consumption was comparable in hyperten...

Among the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.

Background/Aims: Hypertensive nephroangiosclerosis is associated with progressive increase of intrarenal vascular resistance. In addition to blood pressure, other factors can contribute to hypertensive renal damage including a prothrombotic state. We investigated the relationship between hemostatic markers and intrarenal vascular resistance in hypertension. Methods: In 115 untreated, nondiabetic, hypertensive subjects free of cardiovascular complications and advanced renal function impairment, we measured 24-hour creatinine clearance (GFR) and urinary albumin excretion (UAE), fasting plasma glucose, HOMA-index, and plasma levels of fibrinogen, D-dimer, prothrombin fragment 1+2, plasminogen activator inhibitor-1, homocysteine, and lipoprotein(a). In all patients, measurement of intrarenal resistance was obtained by renal Doppler ultrasound with calculation of the renal resistance index (RI). Results: Patients in the highest tertile of RI were older and had greater body mass index, pulse pressure, fibrinogen, and D-dimer levels and lower GFR than patients in the lowest RI tertile. RI was directly correlated with age, pulse pressure, HOMA-index, UAE, D-dimer, and inversely with GFR. On multivariate analysis, RRI was independently associated with age, GFR, and plasma D-dimer. Conclusions: A prothrombotic state is associated with increased intrarenal vascular resistance in nondiabetic hypertensive patients and might contribute to the early stages of hypertensive renal disease.

No abstract