ASYMMETRIC LEFT-VENTRICULAR REMODELING DUE TO ISOLATED SEPTAL THICKENING IN PATIENTS WITH SYSTEMIC HYPERTENSION AND NORMAL LEFT-VENTRICULARMASSES

Early identification of left ventricular (LV) structural changes may h ave an impact on the outlook of patients with essential hypertension. Of 669 untreated hypertensive subjects, 496 (74%) with normal LV mass at echocardiography (<125 g/m(2)) were grouped according to normal LV geometry (n = 303; 61%), asymmetric LV remodeling due to isolated sept al thickening (n = 111; 22%), asymmetric LV remodeling due to isolated posterior wall thickening (n = 5; 1%), or concentric LV remodelling d ue to septal and posterior wall thickening (n = 77; 16%). Remodeling w as defined as twice the thickness of septum or posterior wall divided by the internal diameter at end diastole >0.45. Twenty-four-hour nonin vasive ambulatory blood pressure (BP) monitoring was performed in all subjects. Compared with subjects with normal LV geometry, those with a symmetric LV remodeling due to isolated septal thickening showed incre ased clinic BP (158/100 vs 153/97 mm Hg, both p <0.05), mean daytime a mbulatory BP (144/95 vs 138/90 mm Hg, both p <0.01), mean nighttime am bulatory BP (128/80 vs 122/76 mm Hg, both p <0.01), LV mass (99 vs 89 g/m(2), p <0.001), total peripheral resistance (1,881 vs 1,562 dynes s cm(-5), p <0.01) and known duration of hypertension (5.5 vs 3.6 years , p <0.01) and decreased stroke index (39 vs 47 ml/m(2), p <0.01). Com pared with subjects with isolated septal thickening, those with concen tric LV remodeling had a longer duration of hypertension (8.3 years, p <0.05), increased peripheral resistance (2,216 dynes s cm(-5), p <0.0 1), decreased stroke index (32.6 ml/m(2), p <0.01), and a slightly inc reased nighttime systolic: BP, but no differences in clinic BP, daytim e BP and LV mass. In summary, 22% of untreated hypertensive subjects w ith normal LV mass have a distinct geometric pattern of asymmetric LV remodeling due to isolated relative increase in the septal thickness. This early and frequent structural abnormality of the left ventricle i s accompanied by clinical characteristics potentially associated with increased cardiovascular risk.