VASCULAR CHANGES IN HYPERTENSIVE PATIENTS WITH DIFFERENT LEFT-VENTRICULAR GEOMETRY

Objective: To evaluate vascular structural changes in hypertensive pat ients with different patterns of left ventricular geometry. Design and methods: From 250 untreated hypertensive patients who underwent ambul atory blood pressure monitoring and echocardiographic study, we select ed four groups matched for sex, age, body mass index, smoking habits a nd serum lipid values: 25 hypertensive subjects with normal left ventr icular geometry, 16 with concentric left ventricular remodeling, 26 wi th concentric left ventricular hypertrophy and 18 with eccentric non-d ilated left ventricular hypertrophy. These patients underwent carotid ultrasonography to evaluate the intimal-medial thickness and lumen dia meter, and venous occlusion plethysmography to record minimum forearm vascular resistance (an index of arteriolar structural changes). Resul ts: The intimal-medial thickness and minimum forearm vascular resistan ce were significantly higher (both P<0.05) in hypertensive subjects wi th concentric left ventricular remodeling (0.95mm, 2.68RU) and concent ric left ventricular hypertrophy (0.96mm, 2.71RU) than in those with e ccentric non-dilated left ventricular hypertrophy (0.81mm, 2.36RU) and normal left ventricular geometry (0.71mm, 2.15RU). There was no diffe rence between hypertensive patients with concentric left ventricular r emodeling and concentric left ventricular hypertrophy. The intimal-med ial thickness and minimum forearm vascular resistance tended to be hig her in hypertensive subjects with eccentric non-dilated left ventricul ar hypertrophy than in those with normal left ventricular geometry, bu t this difference did not attain statistical significance. Conclusions : This study shows that the spectrum of cardiac adaptation to hyperten sion is associated with a spectrum of vascular adaptation which might be related both to hemodynamic stimuli and differences in the expressi on or activity of vascular growth factors.