LEFT-VENTRICULAR CONCENTRIC REMODELING AND CAROTID STRUCTURAL-CHANGESIN ESSENTIAL-HYPERTENSION

Aim Left ventricular concentric remodelling defines a modified left Ve ntricular geometry in the presence of a normal left ventricular mass; it is an early and frequent adaptation in arterial hypertension, The p resent study was designed to evaluate the extent of carotid structural changes in essential hypertensives with left ventricular remodelling. Patients and methods Two groups of hypertensive patients, who had nev er previously received antihypertensive treatment, 14 with left ventri cular concentric remodelling (group I, relative wall thickness 0.48 +/ - 0.02) and 48 with normal left ventricular geometry (group II, relati ve wall thickness (0.37 +/- 0.04) underwent clinical and laboratory ex amination, echocardiography, carotid artery ultrasonography and 24 h a mbulatory blood pressure monitoring (ABPM). The left ventricular dimen sions and mass were obtained according to the Penn convention. The int ima-media thickness (IMT) of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the bulb and the av erage value was used for analysis. Results In both groups age (group I 44 +/- 9 years; group II 40 +/- 9 years), body surface area (group I 1.85 +/- 0.2 m(2); group II 1.80 +/- 0.2 m(2)), duration of hypertensi on (group I 4.4 +/- 4; group II 3.8 +/- 3.9 years), metabolic paramete rs and smoking habits were similar. Both clinic and 24 h ABPM values w ere higher in group I (clinic 157 +/- 12/102 +/- 5; 24 h ABPM 145 +/- 10/95 +/- 7 mmHg) than they were in group II (clinic 146 +/- 11/97 +/- 5: 24 h ABPM = 134 +/- 10/87 + 8 mmHg, P<0.01). The left ventricular mass index (LVMI) and IMT were found to be slightly but significantly greater in group I than they were in group tl (LVMI 106 +/- 7 versus 9 8 +/- 12 g/m(2), P < 0.05; IMT 0.68 +/- 0.13 versus 0.61 +/- 0.10 mm, P < 0.05). A significant correlation was found between LVMI and common carotid IMT in the whole group of hypertensive patients (r = 0.43, P < 0.01). Conclusions Our results indicate that left ventricular concen tric remodelling does not represent the only early cardiovascular chan ge in arterial hypertension but rather is associated often with caroti d intima-media thickening.