Diastolic function of the heart in untreated primary hypertension.

Abstract

SUMMARY To study left ventricular (LV) diastolic function of the heart in relation to blood pressure (BP) and other signs of hypertensive cardiac and peripheral vascular changes, isovolumic relaxation time and early diastolic filling were determined in four BP groups of untreated 49-year-old men: normotensive subjects (n = 20), men with borderline hypertension (n = 30), mild hypertension (n = 45), and moderate to severe hypertension (n = 24). Isovolumic relaxation time, measured as the distance between aortic closure (A 2 , phonocardiography) and mitral valve opening (echocardiography), and early diastolic filling, measured as the distance between mitral valve opening and the O point of the apexcardiogram, tended to increase with BP level, and the total interval from aortic closure to the O point (A 2 O interval) was significantly prolonged in the two groups with mild and moderate to severe hypertension. A prolonged A 2 O interval (>117% of expected value at observed heart rate) was seen in several hypertensives, who had no obvious increase in LV wall thickness on M mode echocardiography. This suggests that a prolonged LV relaxation time may be an early sign of cardiac involvement in primary hypertension. In the group with moderate to severe hypertension, an increase in LV wall thickness was seen together with an increase in resistance at maximal dilation in the calf. This supports the theory that when changes in cardiac structure develop they occur in parallel with structural changes also in the periphery. (Hypertension 6: 329-338, 1984) KEY WORDS • primary hypertension • left ventricular relaxation time • wall thickness • structural vascular changes I N recent years it has been recognized that disturbances in diastolic function of the heart are as important components of left ventricular (LV) dysfunction as an impaired inotropic state. Diastolic abnormalities of the LV have been demonstrated in ischemic heart disease, dilated and hypertrophic cardiomyopathies, and LV hypertrophy.1 " 7 The development of reliable indices of LV relaxation and filling allows us today to study noninvasively the diastolic function of the heart in asymptomatic patients. Such studies have revealed disturbances of LV relaxation and filling in patients with mild hypertension. This suggests that these diastolic abnormalities may be characteristic of early hypertensive heart disease. In the present study, the period of LV relaxation and early filling was determined in 119 middle-aged men and covered a wide blood pressure (BP) range to elucidate whether impairment of diastolic function is an early indicator of cardiac involvement in essential hypertension and to study the dependence of LV relaxation time on changes in LV wall thickness and some other pertinent variables. The investigation was further aimed at studying how cardiac structural changes are related to signs of increased resistance in peripheral vascular beds. Subjects and Methods Study PopulationWe recruited a study population of untreated men with BP varying from very low ...

Effect of Cilnidipine on Left Ventricular Diastolic Function in Hypertensive Patients as Assessed by Pulsed Doppler Echocardiography and Pulsed Tissue Doppler Imaging

“…[6][7][8][9] Conversely, a number of studies on LV diastolic function in hypertensive patients show that diastolic dysfunction occurs before LV hypertrophy or systolic dysfunction. 2,3,10 Parameters obtained from the transmitral flow velocity pattern correlated closely with parameters obtained by left ventriculography 11 and radionuclide angiography. 12 Therefore, the transmitral flow velocity pattern is widely used to evaluate LV diastolic function in clinical settings.…”

Early abnormalities in left ventricular diastolic function of sodium-sensitive hypertensive patients

“…LVH in the hypertensive subject is characterised by the growth of cardiac myocytes and associated with an increased work load, 34 and an activation of non-myocytic cells (cardiac fibroblasts, vascular smooth muscle, endothelial cells). The diastolic dysfunction, on the other hand, in which we detected active myocardial relaxation, and which takes place prior to the development of LVH, 35 may be attributed to a reduction in ventricular distensibility or to altered ventricular compliance, without any change in the ventricular elastic properties. Several factors may be implicated in these initial alterations of the echocardiographic parameters.…”

Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

“…In comparison with Doppler-derived indices of diastolic filling, the videodensitometric parameters showed a significantly higher ability to discriminate between hypertensive subjects and normal controls. [1][2][3][4][5][6] Some experimental 7-10 and autopsy 11-14 data support the hypothesis that arterial hypertension per se could contribute to both an increase in intramyocardial fibrosis and an alteration in the microcirculatory system. A quantitative analysis of the 2-dimensional spatial pattern or the "texture" of the echocardiographic images represents a useful approach that allows ultrasound myocardial tissue characterization (quantitative texture analysis).…”