HIGH PREVALENCE OF CONCENTRIC REMODELING IN ELDERLY INDIVIDUALS WITH ISOLATED SYSTOLIC HYPERTENSION FROM A POPULATION SURVEY

Echocardiographic determination of left ventricular mass index (LVMI) is shown to be valuable in the assessment of cardiovascular risk. Dete rmination of left ventricular geometry, including concentric remodelin g, provides additional prognostic information. In isolated systolic hy pertension (ISH), the few echocardiographic studies available show an increased LVMI, but criteria and patient populations differ. No compar ison with diastolic hypertension (DH) has been made, nor has left vent ricular geometry (with concentric remodeling) been evaluated. We compa red both LVMI and left ventricular geometry of newly diagnosed ISH sub jects-with normotensive and DH subjects, all previously untreated and from the same population. The echocardiographic LVMI of 97 previously untreated ISH subjects (4x systolic pressure greater than or equal to 160 mm Hg, diastolic pressure <95 mm Hg) was clearly elevated compared with Values in age- and sex-matched normotensive subjects (98 and 71 g/m(2), respectively; P<.001). The geometric pattern was abnormal in m ost ISH subjects, with a high prevalence (43 %) of concentric remodeli ng. Both LVMI and left ventricular geometry of ISH subjects did not di ffer significantly from Values in DH subjects (LVMI, 92 g/m(2); concen tric remodeling, 56 %). Sex differences in LV geometry in ISH were pre sent only with the Framingham criteria, not with the Koren criteria. T his study shows a high prevalence of concentric remodeling in elderly individuals with previously untreated ISH. The increase of LVMI and ab normality in left ventricular geometry are comparable with those in DH subjects, further defining the place of ISH as a cardiovascular risk factor in the elderly. Whether there are sex differences in cardiac ad aptation in ISH and whether the geometric classifcation can be used to adjust treatment remain to be investigated.