Impact of ambulatory blood pressure on left ventricular diastolic dysfunction in uncomplicated arterial systemic hypertension

Galderisi, Maurizio; Petrocelli, Antonio; Alfieri, Alfonso; Garofalo, M; Divitiis, Oreste de

doi:10.1016/s0002-9149(97)89313-7

Cited by 55 publications

(31 citation statements)

References 24 publications

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“…To our knowledge, this is the first study to divide a study population by age and presence of left ventricular hypertrophy in order to study left ventricular diastolic performance. In the pooled population, age, interventricular septum thickness in diastole and left ventricular posterior wall thickness in diastole were the independent predictors of the E/A ratio, in agreement with previous studies [17]. In younger patients with left ventricular hypertrophy, mean systolic blood pressure during the night was the only independent predictor of the E/A ratio, whereas in elderly patients without left ventricular hypertrophy, mean heart rate during the day and mean pulse pressure during the night were the parameters that independently affected this index.…”

Section: Discussionsupporting

confidence: 92%

Pulse Pressure and Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Trika

Toumanidis²,

Stamatelopoulos³

et al. 2004

Cardiology

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Background: Impaired left ventricular diastolic function is a common finding in essential hypertension. Methods: In order to investigate possible relationships between flow velocity through the mitral valve (E/A; index of left ventricular diastolic function) and 24-hour blood pressure and heart rate variations, 198 patients with mild to moderate essential hypertension were studied by Doppler echocardiography and ambulatory blood pressure monitoring. They were divided according to age into group 1 (n = 88, age 40–54 years) and group 2 (n = 110, age 55–79 years). Each group was divided into subgroups with (1a, 2a) or without (1b, 2b) left ventricular hypertrophy according to the end-diastolic posterior wall thickness and/or the interventricular septum thickness. Results: In a multivariate stepwise regression analysis, age (β = –0.25, p < 0.0001), posterior wall thickness (β = –0.31, p < 0.0057) and mean heart rate during the day (β = –0.34, p < 0.0284) were the independent predictors of E/A in the pooled population. In group 1a (young subjects with left ventricular hypertrophy), mean systolic blood pressure during the night (β = –0.33, p < 0.041) was the only independent predictor of E/A. In the elderly group without left ventricular hypertrophy (group 2b), the mean heart rate during the day (β = –0.44, p < 0.0000) and mean pulse pressure during the night (β = –0.60, p < 0.0007) were the independent predictors of E/A. Conclusions: The new finding provided by this study is that in elderly hypertensive patients without left ventricular hypertrophy, a large pulse pressure at night may serve as an independent predictor of abnormal left ventricular diastolic filling.

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Section: Discussionsupporting

confidence: 92%

Pulse Pressure and Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Trika

Toumanidis²,

Stamatelopoulos³

et al. 2004

Cardiology

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“…This finding is in contrast with previously published results 12,13 showing a significant correlation between ABP indices and diastolic dysfunction; however, these studies analyzed normal subjects and hypertensive patients as a continuum, and this may have given rise to a spurious correlation since hypertensive patients can be expected to have lower values of E/Ac and higher values of ABP than normal subjects. On the other hand, pressure load was associated with the occurrence of LVH.…”

Section: Pitzalis Et Al May 1999systolic Blood Pressurecontrasting

confidence: 85%

Diastolic Dysfunction and Baroreflex Sensitivity in Hypertension

et al. 1999

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Abstract-The determinants of diastolic dysfunction in patients with systemic hypertension are not completely known. To evaluate the possible role of age, arterial blood pressure, and baroreflex heart rate response impairment in causing diastolic dysfunction, we studied 61 patients (42 male; meanϮSD age, 43.9Ϯ12 years) with newly recognized and therefore previously untreated systemic hypertension. Diastolic dysfunction was evaluated by means of Doppler echocardiography (and diagnosed as such when the early to atrial peak velocity ratio corrected to heart rate was Ͻ1), arterial blood pressure by 24-hour ambulatory monitoring, and baroreflex heart rate response by means of the spectral technique (␣ index) during paced (0.27 Hz) and spontaneous breathing (in a supine position and during tilt). Nineteen patients had diastolic dysfunction, the most powerful predictor of which was age (rϭϪ0. T he cause and time of occurrence of cardiac impairment in patients with essential hypertension are not precisely known. It has been shown that diastolic dysfunction is the earliest cardiac abnormality in this patient population 1 and may precede ventricular hypertrophy. 2 Age and pressure load are considered possible determinants, 3 whereas the role of the autonomic nervous system is still debated. Animal studies have suggested that a high sympathetic tone may favor the development of hypertrophy, 4 but the role of the autonomic nervous system in the genesis of cardiac abnormalities is unclear. Some studies have reported increased sympathetic activity in hypertensive patients with cardiac hypertrophy, 5 but this has not been confirmed by other authors. 6 Furthermore, no data are yet available concerning the role of depressed baroreflex sensitivity in determining cardiac impairment in these patients. It is possible that it is too late for any autonomic nervous system abnormalities to be detected once hypertrophy becomes evident, and therefore the early phase of essential hypertension could offer important information on the role of autonomic nervous system activity in determining the presence of cardiac involvement.The purpose of this study was to evaluate the role of pressure load and baroreflex heart rate response in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated mild to moderate essential hypertension. Methods Study PopulationThe study involved 61 consecutive patients referred to our outpatient clinic for previously untreated mild to moderate hypertension. Only the patients whose diastolic blood pressure was Ͼ90 mm Hg at 3 different examinations were included in the study. All of the patients were asymptomatic and underwent a full medical examination, 12-lead ECG, routine laboratory tests, and a treadmill stress test to rule out neurological disease, secondary hypertension, and coronary artery disease. Obese (body mass index Ͼ30 kg/m 2 ) and diabetic patients were also excluded. The control group consisted of 15 nonhospitalized healthy volunteers (10 male; m...

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“…[20][21][22] One major finding of this study is that both blood pressure and LV wall thickness independently influence diastolic function (as assessed by the E/ A-ratio, E-dec or IVRT). 23,24 The present observation that increased blood pressure is related to impaired diastolic function demonstrates the haemodynamic influence of blood pressure on LV diastolic function. 21,25 Thus, an elevated blood pressure will increase LV wall tension, which is a major determinant for myocardial hypertrophy and subsequent diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 52%

Blood pressure and left ventricular geometric pattern determine diastolic function in hypertensive myocardial hypertrophy

et al. 2003

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Abnormal left ventricular (LV) diastolic relaxation is an early sign of hypertensive heart disease. Whether LV diastolic dysfunction is caused directly by raised blood pressure, or by structural changes related to LV hypertrophy remains controversial. We examined 115 hypertensive patients with LV hypertrophy, and two ageand gender-matched groups (38 hypertensive patients without LV hypertrophy and 38 normotensive subjects) by echocardiography to assess determinants of LV diastolic function, and the relation between diastolic function and LV geometric pattern. Diastolic function was evaluated by the E/A-ratio, E wave deceleration time (E-dec), isovolumic relaxation time (IVRT), and the atrioventricular plane displacement method (AV-LA/AVmean). A multivariate analysis (including gender, age and body mass index) shows diastolic function to be inversely related to blood pressure, LV wall thickness and LV mass, but not to LV end diastolic diameter. The E/A-ratio generally showed the strongest relations. Only the E/A-ratio and AV-LA/AV-mean were related to heart rate. By stepwise regression analysis, age was the strongest determinant for the E/A-ratio, E-dec and AV-LA/AV-mean, followed by systolic blood pressure, heart rate and LV wall thickness. For IVRT, however, LV wall thickness appeared strongest, followed by systolic blood pressure and age. In conclusion, blood pressure and LV wall thickness both have independent influence on LV diastolic function. Age and blood pressure are the most important factors to determine the E/A-ratio and Edec, whereas LV geometry and blood pressure are most important when IVRT is used. AV-LA/AV-mean may not be useful in hypertensive LV hypertrophy.

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Impact of ambulatory blood pressure on left ventricular diastolic dysfunction in uncomplicated arterial systemic hypertension

Cited by 55 publications

References 24 publications

Pulse Pressure and Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Pulse Pressure and Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Diastolic Dysfunction and Baroreflex Sensitivity in Hypertension

Blood pressure and left ventricular geometric pattern determine diastolic function in hypertensive myocardial hypertrophy

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