Diastolic function of the hypertrophied left ventricle in primary hypertension

Wikstrand, John

doi:10.1111/j.1475-097x.1986.tb00060.x

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…Our results, showing that the smaller increase in CO during hyperventilation is followed by a shorter duration of PHVH in patients with essential hypertension, and that there was a significant correlation between changes in CO and duration of PHVH in hypertensives, substantially support this hypothesis and suggest a causal relationship between these two phenomena. The small increase in CO in hypertensive patients observed in our study is in agreement with previous observations showing that hypertensive patients have a less pronounced increase in CO during exercise as a consequence of the poor functional reserve of the left ventricle [9,14]. In our study CO, was measured noninvasively by the indirect Fick method because a more invasive procedure would not have been justified for the purpose of the study.…”

Section: Discussionsupporting

confidence: 81%

“…Thus, it has been suggested that the increase in CO occurring during voluntary hyperventilation may affect the duration of PHVH [2]. It is also known that, in hypertensive patients, the increase of CO in response to exercise is less pronounced [9]. Therefore, if PHVH is influenced by the rise in CO during voluntary hyperventilation, hypertensive patients are expected to have a shorter duration of PHVH, thus providing a model to study the determinants of the PHVH phenomenon in humans.…”

Section: Aamentioning

confidence: 99%

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The relationship between cardiac output and posthyperventilation hyperpnoea in patients with essential hypertension

Bellofiore¹,

Malatino²,

Sapienza³

et al. 1998

Eur Respir J

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aaFollowing abrupt cessation of voluntary hyperventilation, ventilation declines gradually towards the baseline. This phenomenon has been called posthyperventilation hyperpnoea (PHVH), and it is believed to be due to the activation of a reverberating circuit of neurons in the respiratory centre area [1]. This reverberating circuit is activated along with the respiratory neurons and provides sufficient input to the respiratory centres to maintain ventilation after the decrease in chemoreceptor activity [1]. It has been demonstrated that different factors, such as the changes in arterial pH and CO 2 tension [2,3], blood progesterone levels [4], and respiratory frequency during hyperventilation [3], can affect the duration of PHVH.It is well known that increases in cardiac output (CO) are followed by an increase in respiratory frequency and minute ventilation (V'E) in dogs [5,6]. However, there is evidence that during voluntary hyperventilation CO is substantially raised in healthy subjects [7,8]. Thus, it has been suggested that the increase in CO occurring during voluntary hyperventilation may affect the duration of PHVH [2]. It is also known that, in hypertensive patients, the increase of CO in response to exercise is less pronounced [9]. Therefore, if PHVH is influenced by the rise in CO during voluntary hyperventilation, hypertensive patients are expected to have a shorter duration of PHVH, thus providing a model to study the determinants of the PHVH phenomenon in humans. To test this hypothesis, the duration of PHVH and the changes in CO during voluntary hyperventilation in patients with essential hypertension and in healthy subjects were assessed. Materials and methodsWe studied 20 male patients with essential hypertension (age range: 29-62 yrs) and 12 age-matched male healthy subjects (controls). Four hypertensives and two controls were current smokers. The mean values (±SEM) of arterial blood pressure were 178/107±3/1 and 121/71±2/2 mmHg in hypertensives and controls, respectively. Hypertensive patients belonged to stage I or II of the World Health Organization (WHO) classification and showed no concurrent illness, including respiratory tract disorders. Antihypertensive drugs were withdrawn Š4 weeks before the study. Subjects were not allowed to drink beverages containing xanthines for Š24 h before the study. The study was approved by the Ethics Committee of the University of Catania, and each subject gave informed consent to participation in the study.Subjects were seated and breathing through a face mask to which was attached a turbine flow head to measure airflow. A sampling line for the collection of end-expiratory gases was also connected to the face mask. After 10 min of quiet breathing, subjects were asked to perform sustained This hypothesis was tested by measuring the duration of PHVH in patients with essential hypertension, in whom the increase in CO as a result of various stimuli is less pronounced. Twenty male hypertensives (mean arterial blood pressure±SEM: 178/ 107±3/1 mmHg), and 12 age-match...

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Section: Discussionsupporting

confidence: 81%

Section: Aamentioning

confidence: 99%

The relationship between cardiac output and posthyperventilation hyperpnoea in patients with essential hypertension

Bellofiore¹,

Malatino²,

Sapienza³

et al. 1998

Eur Respir J

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“…Duration of diastole may be of importance in elderly hypertensive patients with hypertrophied left ventricle [18], The present study has shown that the relative length of diastole per beat (DT%) is of prognostic importance with respect to death in patients treated with timolol after acute myocardial infarction. The total length of diastole…”

Section: Methodsmentioning

confidence: 90%

Diastolic Time in Patients Treated with Timolol or Placebo after Acute Myocardial Infarction

Brubakk¹,

Bergan²,

Pedersen³

et al. 1993

Am J Noninvas Cardiol

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β-Blockers reduce mortality after acute myocardial infarction. Prolongation of the diastole may be one favorable effect from ß-blockers. In this study, 55 patients were allocated to timolol treatment and 54 to placebo treatment after acute myocardial infarction. During follow-up, 26 patients died, 5 in the timolol and 21 in the placebo group. The patients were examined at baseline and after 1 and 12 months of treatment. Both at 1 and 12 months, diastolic time in percent of normal values (DT%) was significantly longer in the timolol than in the placebo group of patients (p = 0.0017 and 0.0067, respectively). The regression equations between DT and the R-R distance had a significantly steeper slope in the timolol than in the placebo group at 1 month (95% Cl -0.14 to -0.029). The total length of diastole per minute (heart rate, HR x DT) was significantly longer in the timolol group at 1 and 12 months (p < 0.0001). In the timolol group, DT% and total diastole were significantly longer in the survivors than in the nonsurvivors at the last registration (p = 0.0302 and 0.0012, respectively). In the placebo group, only total diastole was significantly longer in the survivors (p = 0.032). The findings of the study indicate that the length of the diastole is a prognostic factor with respect to survival after acute myocardial infarction and that timolol has a lengthening effect on diastole beyond the effect of reduced HR.

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“…Note that when heart rate is lowered from 100 to 80 beatsimin, the time available for filling increases 2-fold. (From reference 59) blockers were effective in reducing myocardial infarction and sudden cardiac death in secondary prevention studies in which at least one-third of the patients were hypertensive.…”

Section: Discussionmentioning

confidence: 99%

Initial Therapy for Mild Hypertension

Wikstrand

1986

Pharmacotherapy

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The treatment of mild hypertension has been a subject of controversy because its benefits versus risks are not as well established as they are for moderate to severe hypertension. Results of several studies, however, now show that treatment reduces the frequency of stroke in those with milder blood pressure elevations. New guidelines published by the Joint National Committee recommend that treatment of mild hypertension begin with either a diuretic or a beta blocker. The effect on the most common complication of mild hypertension, that is, coronary heart disease (myocardial infarction and sudden cardiac death), has, however, not been encouraging in studies in which diuretics have been used as first-line treatment. Two large-scale primary preventive studies compared the efficacy of diuretics and beta blockers in reducing coronary heart disease in hypertensive patients; results were in favor of beta blocker regimens in men. So far there is some evidence, but no hard scientific proof, that certain beta blockers offer advantages over diuretics in preventing myocardial infarction and sudden cardiac death in hypertensive patients. A major concern with the use of diuretics is the risk of hypokalemia; this can be reduced when they are combined with beta blockers.

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Diastolic function of the hypertrophied left ventricle in primary hypertension

Cited by 10 publications

References 28 publications

The relationship between cardiac output and posthyperventilation hyperpnoea in patients with essential hypertension

The relationship between cardiac output and posthyperventilation hyperpnoea in patients with essential hypertension

Diastolic Time in Patients Treated with Timolol or Placebo after Acute Myocardial Infarction

Initial Therapy for Mild Hypertension

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