Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function

Fouad, Fetnat M.; Słomiński, Jan Marek; Tarazi, Robert C.

doi:10.1016/s0735-1097(84)80289-2

Cited by 343 publications

(106 citation statements)

References 16 publications

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“…It is well known that diastolic function is influenced by several factors, such as age, preload, LV mass, and BP load. 33,38,39 However, the difference found between Fϩ and FϪ groups cannot be ascribed to differences between groups in terms of age, BMI, or 24-hour BP profile, as underlined above, or to differences in preload or LV hypertrophy, in view of the fact that LV end-diastolic diameter, index of preload, and LV mass index were similar between the 2 lean groups and between the 2 obese groups. From multiple regression analysis, in addition to LV mass index and BMI, stimulated insulinemia and genetic predisposition to hypertension were also significant predictors of LV diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 94%

Insulin and Diastolic Dysfunction in Lean and Obese Hypertensives

et al. 1999

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Abstract-We investigated the influence of genetic predisposition to hypertension by studying the relation between insulin sensitivity and left ventricular (LV) mass and function in untreated lean and obese hypertensives. We selected 50 lean hypertensives with normotensive parents (negative family history of hypertension [FϪ]), 64 lean hypertensives with 1 or both parents hypertensive (positive family history of hypertension [Fϩ]), 40 obese FϪ hypertensives, and 43 obese Fϩ hypertensives. The 4 groups were comparable regarding age, gender, 24-hour blood pressure profile, and known duration of hypertension. We measured glucose, insulin, and C-peptide during fasting and during an oral glucose tolerance test; LV morphology and function were assessed by digitized M-mode echocardiography. Glucose (fasting and test) levels were normal in all and similar among the 4 groups. Insulin and C-peptide (fasting and stimulated) levels were higher in obese hypertensives than in lean hypertensives; at similar body mass index, insulin and C-peptide levels were higher in Fϩ than in FϪ groups. Compared with lean hypertensives, obese hypertensives had greater LV mass index; LV systolic function was normal in all and similar among the groups. The indices of LV diastolic function were significantly lower in Fϩ than in FϪ groups. LV mass index did not correlate with metabolic parameters; the indices of LV diastolic function were inversely correlated with insulin area during test in only the 2 Fϩ groups. In conclusion, genetic predisposition to hypertension is associated with a reduced insulin sensitivity and affects the response of the myocardium to increased insulin levels, inducing a greater impairment of diastolic function. Insulin sensitivity and genetic predisposition to hypertension seem to have no influence on LV mass. (Hypertension. 1999;34:1208-1214.)Key Words: insulin Ⅲ diastole Ⅲ hypertension, essential Ⅲ obesity Ⅲ hypertrophy E ssential hypertension and obesity are often associated, and each one, per se, can induce myocardial hypertrophy and left ventricular (LV) diastolic dysfunction. 1-5 Insulin resistance and hyperinsulinemia have been described in both hypertension and obesity. 6,7 In experimental studies, insulin has been demonstrated to exert a growth-stimulating effect on cardiomyocytes and to increase collagen production in fibroblasts 8 -12 ; therefore, clinical studies have evaluated the possible contribution of insulin resistance and hyperinsulinemia to the development of myocardial hypertrophy and diastolic dysfunction in hypertension and in obesity and have obtained conflicting results. [13][14][15][16][17][18][19][20] Recently, it has been suggested that genetic factors play an important role in the link between insulin resistance, hypertension, and obesity. In fact, a reduced insulin sensitivity has been demonstrated in lean and obese normotensives and hypertensives with hypertensive parents (positive family history of hypertension [Fϩ]) compared with offspring of normotensive parents (negative family history...

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Section: Discussionmentioning

confidence: 94%

Insulin and Diastolic Dysfunction in Lean and Obese Hypertensives

et al. 1999

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“…Studies conducted on hypertensive patients demonstrated a direct relationship between the degree of LVH and impairment of diastolic filling. 29) Tsioufis, et al 12) demonstrated that compared to their counterparts without EBPR, hypertensives with EBPR were characterized by more pronounced LV diastolic dysfunction assessed by TDI. In our HTN subjects, however, no statistically significant difference was noticed in LV diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

et al. 2013

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SummaryThis study was conducted to study left ventricular hypertrophy (LVH), diastolic dysfunction, pulse pressure (PP), and plasma endothelin (ET)-1 level in amateur marathon runners with an exaggerated blood pressure response (EBPR) to exercise. The study participants included normotensive marathon runners (NM, n = 15), EBPR marathon runners (EBPR, n = 17), normotensive sedentary individuals (CON, n = 13), and hypertensive patients (HTN, n = 14). An integrated M-mode/2-dimensional echocardiographic analysis was performed. Plasma ET-1 levels at resting were measured using a commercial ELISA kit. LV wall thickness and end-diastolic dimensions as well as LV mass index (LVMI) were higher in EBPR than in CON. There were no differences in systolic function among the groups. Analysis of diastolic function, such as lower Em and higher E/Em ratio on TDI, showed a worse relaxation pattern in EBPR. Despite LVH, NM subjects showed no abnormality of LV diastolic dysfunction. HTN subjects in the early stage of their disease showed a slightly modified LV structural and diastolic function, but there was no statistical difference compared with CON. The E/Em ratio was significantly correlated with PP and LVMI. LVMI was significantly correlated with PP. There was a significant difference in plasma ET-1 concentration between marathon runners and hypertensive subjects. We demonstrated that marathon runners with EBPR showed an increase in LVMI and diastolic dysfunction more than HTN subjects in the early stage. PP was significantly related to these two variables. Caution should be exercised when connecting LVH and diastolic dysfunction with plasma ET-1 concentration in all marathon runners. (Int Heart J 2013; 54: 82-87)Key words: Endothelin-1, Marathon A thlete's heart is a well known condition characterized by structural, electrical, and functional adaptations of the myocardium consequent to regular physical training and consistent with the intensity, duration, and type of activity.1,2) To date, conflicting data have been reported concerning the nature (physiologic versus pathologic) of left ventricular hypertrophy (LVH) in master athletes and veterans. [3][4][5][6] Exaggerated blood pressure response (EBPR) during exercise is associated with increased risk of worsening hypertension in normotensives, as well as in subjects with high normal blood pressure (BP). 7,8) Moreover, EBPR might be related to adverse cardiovascular outcomes, partially due to its association with indices of target-organ damage such as LVH, abnormal geometry, or carotid atherosclerosis. [9][10][11] In addition, diastolic dysfunction of the LV frequently accompanies EBPR. 12)However, we do not know whether EBPR in athletes would show the same features associated with abnormal LV remodeling and diastolic dysfunction. Recently, we have unofficially found numerous cases of EBPR to exercise in Korean nonathletic marathon runners. Marathons have become a popular leisure activity in Korea during the last 2 decades and rank first in popularity as a public sport. We t...

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“…15 Fouad et al 16 considers as dynamic factors those conditions which, due to their functional character, may be modified and controlled in a short period of time. Among these factors, afterload, abnormal kinetics of calcium-associated with the development of LVH-general or regional myocardial ischaemia and sympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

Treatment of diastolic dysfunction in hypertensive patients without left ventricular hypertrophy

Molinero

Murga

et al. 1998

J Hum Hypertens

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The aim of this study was to evaluate the influence of verapamil SR 240 mg (V) and the combination amiloride 5 mg + hydrochlorothiazide 50 mg (AH) on diastolic dysfunction of hypertensive patients without left ventricular hypertrophy (LVH). Twenty-six hypertensive patients with diastolic dysfunction, normal systolic function and without LVH were included into a 2-week washout period and then randomised to a 6-month V or AH treatment. One blinded-to-treatment echocardiographist at

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Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function

Cited by 343 publications

References 16 publications

Insulin and Diastolic Dysfunction in Lean and Obese Hypertensives

Insulin and Diastolic Dysfunction in Lean and Obese Hypertensives

Left Ventricular Hypertrophy, Diastolic Dysfunction, Pulse Pressure, and Plasma ET-1 in Marathon Runners With Exaggerated Blood Pressure Response

Treatment of diastolic dysfunction in hypertensive patients without left ventricular hypertrophy

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