IS ISOLATED SYSTOLIC HYPERTENSION IN THE ELDERLY MORE ASSOCIATED WITHLEFT-VENTRICULAR HYPERTROPHY AND SIGNIFICANT CAROTID-ARTERY STENOSIS THAN MIXED HYPERTENSION AND ISOLATED DIASTOLIC HYPERTENSION

The association of electrocardiographic left ventricular hypertrophy ( ECG-LVH) (212 subjects) and haemodynamically significant internal caro tid artery stenosis (ICAS) (27 subjects) with isolated systolic hypert ension (ISH), mixed hypertension (MHT) and isolated diastolic hyperten sion (IDH) was studied in untreated elderly patients. Subjects were th ose aged 67-86 years, drawn from a community screening programme for h ypertension in Wales. The prevalence of ECG-LVH with or without repola risation abnormalities was higher in subjects with ISH (16.6%) than in subjects with mixed hypertension (11.6%, NS). Partial correlation of SBP, DBP, voltage of lead I and SV1 + RV5 for each hypertensive subtyp e showed a consistent positive correlation of DBP with the voltage of lead I and SV1 + RV5 in all the subtypes except with the voltage of le ad I in IDH subjects. In MHT, the SBP was inversely related to both th e voltage of R-wave in lead I and SV1 + RV5 (P < 0.03). In IDH, the SB P was positively correlated with the voltage of R-wave in lead I and i nversely with SV1 + RV5. Atheromatous plaque was present in 40 of 54 ( 74.1%) internal carotid arteries investigated. The homogeneous type of plaque was predominant in ISH (67%). Heterogenous type of plaque was predominant in the MHT group (50%) and IDH group (43%). The normotensi ve group did not show any predilection to any morphological type. Plaq ue was invariably present in the case of ISH, chi(2) = 12.29, 0.1 > P > 0.05. There was more smooth plaque surface in normotensives (79%) an d more rough or pitted plaque surface in hypertensives (all types), ch i(2) = 6.51, 0.1 > P > 0.05. All normotensives and IDH subjects had no n-haemodynamically significant stenosis. Haemodynamically significant stenosis was found in cases of ISH (25%) and MHT (7%); chi(2) = 7.66, 0.1 > P > 0.05. ECG-LVH and haemodynamically significant internal caro tid artery stenosis were more commonly found in subjects with ISH than in subjects with MHT. Further studies with larger numbers of patient in each hypertensive subtype would be desirable to confirm these obser vations.