The heart in the hypertensive elderly

Grodzicki, Tomasz; Messerli, F. H.

doi:10.1038/sj.jhh.1000671

Cited by 6 publications

(6 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PWd, posterior wall thickness (diastolic); PWs, posterior wall thickness (systolic); AWd, anterior wall thickness (diastolic); AWs, anterior wall thickness (systolic); LVDd, left ventricular diastolic dimension; LVDs, left ventricular systolic dimension; EFS (%), endocardial fractional shortening; epi-D, epicardial dimension; epi-V, epicardial volume; Vold, end diastolic volume; Vols, end systolic volume; RWth, relative wall thickness; SV, stroke volume; CI, cardiac index; Peak E, maximal early diastolic transmitral flow velocity; Peak A, maximal late diastolic (atrial contraction induced) transmitral flow velocity; E/A, Peak E/Peak A ratio; NS, not significant. observed changes in LV function, including the reduced E/A ratio, are similar to those that have often been observed during adult mammalian aging (18,19,(22)(23)(24)41).…”

Section: Discussionsupporting

confidence: 81%

Model of functional cardiac aging: young adult mice with mild overexpression of serum response factor

Zhang

Azhar

Furr

et al. 2003

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

Serum response factor (SRF) is an important transcription factor that may have a role in the maintenance of cardiac structure and function. The level of SRF mRNA expression increases approximately 16% in the hearts of mice during adult aging. To model the effect of mild SRF elevation in the aging heart, transgenic mice with low levels of SRF overexpression were generated. By 6 mo of age, the transgenic mice had a 19% increase of heart-to-body weight ratio compared with nontransgenic mice. In addition, they had a 12% increase in myocyte size, a 6.7% increase in collagen deposition, and altered gene expression of a number of muscle-specific and cardiac genes. Doppler echocardiography revealed that these transgenic mice had increased left ventricular wall thickness and decreased left ventricular (LV) volumes, increased LV stiffness with 20% reduction in early diastolic LV filling (peak E), and 35% decline in peak E-to-peak A (late diastolic filling) ratio. The observed changes, especially those in the E/A ratio, are similar to those seen clinically in late life as a part of human adult myocardial aging.

show abstract

Section: Discussionsupporting

confidence: 81%

Model of functional cardiac aging: young adult mice with mild overexpression of serum response factor

Zhang

Azhar

Furr

et al. 2003

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

show abstract

“…Clinical benefits observed in patients with post-operative or post-TAVI regression of LVH suggest that drugs with the highest ability to attenuate LVH in arterial hypertension, i.e. renin-angiotensin system (RAS) blockers [2], would be indicated also for this purpose in AS. In fact, angiotensin-converting enzyme blockers (ACEI) and angiotensin receptor blockers (ARB) exert an additional protective effect against LVH, beyond that resulting from blood pressure lowering [2, 56].…”

Section: Renin-angiotensin System Blockade In As – a Tool To Inhibit mentioning

confidence: 99%

“…renin-angiotensin system (RAS) blockers [2], would be indicated also for this purpose in AS. In fact, angiotensin-converting enzyme blockers (ACEI) and angiotensin receptor blockers (ARB) exert an additional protective effect against LVH, beyond that resulting from blood pressure lowering [2, 56]. RAS blockade attenuates both cardiomyocyte hypertrophy and the expansion of extracellular matrix [2, 56], and myocardial fibrosis with overexpression of the angiotensin-converting enzyme accompanies severe AS [57].…”

Section: Renin-angiotensin System Blockade In As – a Tool To Inhibit mentioning

confidence: 99%

“…However, the notion of LVH as an advantageous LV adaptation has been challenged by recent evidence, suggesting that perhaps we have been thinking about LVH incorrectly. In essential hypertension, it has been demonstrated that the degree of LVH is associated with adverse outcomes [2], especially when the magnitude of LVH is disproportionate to LV afterload. Excessive LVH is associated with LV diastolic [3] and subtle systolic dysfunction [3–5] as well as impaired coronary flow reserve [6] in hypertensive subjects, which accelerates the development of heart failure and translates into worse long-term prognosis [7, 8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?

Davies

Zerebiec

Rożanowska

et al. 2018

pwki

View full text Add to dashboard Cite

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.

show abstract

“…LVH is the most ominous preclinical sequela of hypertensive cardiac damage in men and women of all ages. It is a common finding in the elderly 44 and a powerful, independent predictor of premature cardiovascular mortality and death from all causes in both men and women 45–49 . It may present as an increase in LV wall thickness or an increase in LV mass beyond that expected for an individual's body size and age.…”

Section: Left Ventricular Hypertrophymentioning

confidence: 99%

The Role of Echocardiography in Hypertensive Heart Disease in the Elderly

Mensah

2000

American J Geri Cardiology

View full text Add to dashboard Cite

H ypertension is a common disease in the elderly and a major cause of premature mortality and nonfatal cardiovascular complications. In individuals in the U.S. aged ≥60 years, nearly three of four non-Hispanic blacks, 60% of non-Hispanic whites, and 61% of Mexican-Americans have hypertension. 1 In those older than age 70, over 70% of women and nearly 60% of men have hypertension. Elevated systolic blood pressure (BP) with normal diastolic BP, so-called isolated systolic hypertension (ISH), is almost exclusively a disease of the elderly.Although ISH often dominates discussions of hypertension in the elderly, it has a prevalence of only 20%-25%, even in patients 70-80 years of age and older. 2,3 Thus, primary hypertension, with abnormally elevated systolic and/or diastolic BP, is by far the most common form of hypertension in the elderly, as it is in younger adults. The attendant cardiovascular complications take on greater importance in the elderly, because aging itself is a powerful independent predictor of adverse cardiovascular events. The evaluation of cardiovascular damage attributable to hypertension is an important component of risk stratification, which determines the urgency and intensity of treatment as well as the assessment of overall prognosis. It is in this arena that echocardiography has substantial current application and future promise. DEFINITIONSHypertension in the elderly is defined here as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or any BP level in elderly subjects taking antihypertensive medications for the control of BP. 4 ISH is systolic BP ≥140 mm Hg, accompanied by diastolic BP<90 mm Hg. Hypertension may be uncomplicated or can be the cause of substantial structural and functional alterations in the heart and blood vessels. When these The evaluation of target organ damage attributable to hypertension is a crucial component of risk stratification to determine the urgency and intensity of treatment as well as the assessment of overall prognosis. In the cardiovascular system, the spectrum of hypertensive damage includes left ventricular and vascular hypertrophy, heart failure secondary to decreased systolic function, impaired left ventricular diastolic relaxation, reduced left ventricular diastolic compliance, coronary microvascular disease, left atrial abnormality, and dilatation and dissection of the aorta. Echocardiography plays an important role and is frequently the diagnostic modality of choice in these conditions. It provides reliable measures of systolic performance, diastolic function, arterial compliance, atrial and ventricular chamber size, and ventricular mass-all of which may play important roles in decisions about treatment and prognosis. The versatility of echocardiography in these conditions, however, does not justify its routine use in all hypertensive patients. In selected patients and especially in the elderly, where the prevalence of hypertensive target organ damage is high, echocardiography is cost-effective in the evaluation and management of hypertensive heart d...

show abstract

The heart in the hypertensive elderly

Cited by 6 publications

References 43 publications

Model of functional cardiac aging: young adult mice with mild overexpression of serum response factor

Model of functional cardiac aging: young adult mice with mild overexpression of serum response factor

Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?

The Role of Echocardiography in Hypertensive Heart Disease in the Elderly

Contact Info

Product

Resources

About