HEMODYNAMIC AND HUMORAL CORRELATES IN ESSENTIAL-HYPERTENSION - RELATIONSHIP BETWEEN PATTERNS OF LVH AND MYOCARDIAL-ISCHEMIA

While evaluating 45 hypertensive patients with left ventricular hypert rophy (LVH) for enrollment in a clinical research protocol, we had the opportunity to compare anatomic and functional characteristics of tho se with LVH and ischemia on an exercise tolerance test (ETT), but with out coronary artery disease by angiography (group It n=8), versus thos e with a normal ETT (group II, n=37). There were no differences in age , sex, severity, and duration of hypertension between the two groups, but group I patients were significantly more overweight and had a wors e lipid profile. Blood pressure at peak ETT was higher in group I desp ite shorter exercise duration, although resting ambulatory pressures w ere similar. Group I patients had evidence of more pronounced cardiac enlargement and LVH by both ECG and echo criteria and a characteristic pattern of more pronounced thickening at the apex, but both groups ha d equally good systolic function and similar degrees of mild diastolic dysfunction. Analysis of 24-hour ambulatory ECG showed a significantl y greater propensity to ventricular arrhythmias in group I, as shown b y the presence of late potentials in 4 patients, the presence of coupl ets in 3, runs of ventricular tachycardia in 2 (while none of group II patients had late potentials or complex arrhythmias), and an average frequency of isolated premature ventricular contractions approximately three times higher in group I than group II patients. Our data demons trate that hypertensives with LVH associated with myocardial ischemia at stress but with normal coronary arteriograms tend to be more overwe ight, attain a higher systolic blood pressure at ETT despite a shorter duration, have a higher propensity for severe arrhythmias, and have a n adverse lipid profile. LVH in these subjects is more pronounced by b oth ECG and echo criteria and is characterized by predominantly apical . hypertrophy with left atrial and ventricular dilatation rather than overall LV wall thickening.