Diastolic Dysfunction Is Associated with Insulin Resistance, but Not with Aldosterone Level in Normotensive Offspring of Hypertensive Families

Abstract

Background and Aims: We investigated left ventricular (LV) morphology and function in association with insulin level/insulin resistance (IR) and aldosterone level in normotensive offspring of subjects with essential hypertension (familial trait, FT). Methods: The study encompassed 76 volunteers of whom 44 were normotensive with FT (aged 28–39 years) and 32 age-matched controls without FT. LV mass and function were measured using conventional echocardiography and tissue Doppler imaging. LV diastolic function was reported as peak septal annular velocities (E_m and E_m/A_m ratio) in tissue Doppler imaging. Fasting insulin and aldosterone were determined. Results: In subjects with FT, the LV mass was higher than in controls (92.14 ± 24.02 vs. 70.08 ± 20.58 g; p < 0.001). The study group had a worse LV diastolic function than control subjects (lower E_m and E_m/A_m ratio; p < 0.001). In subjects with FT, the E_m/A_m ratio was independently associated with IR (partial p = 0.029 in multivariate model, R² = 0.51), but not with LV mass. The aldosterone level was comparable in both groups. Conclusions: In normotensive individuals with FT, LV morphological and functional abnormalities were found. LV dysfunction but not an increase in LV mass is associated with IR. The aldosterone level is probably not responsible for the development of early hypertensive heart disease.

Target Organ Damage in Essential Hypertension

“…It seems that they are results of various interrelated hemodynamic and non-hemodynamic factors. Sometimes hypertrophy can be detected in the prehypertensive period of evolving hypertension implying that a genetic background could also play a role (Žižek & Poredoš, 2008). One fundamental component of cardiomyocyte response to pressure overload of the LV is a slowing of maximum shortening velocity (V max ).…”