ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR STRUCTURE AND DIASTOLIC FILLING IN ELDERLY SUBJECTS WITH BORDERLINE ISOLATED SYSTOLIC HYPERTENSION (THE FRAMINGHAM HEART-STUDY)

Abnormalities in left ventricular (LV) structure and function have bee n shown in patients with diastolic hypertension and recently in subjec ts with isolated systolic hypertension. The purpose of this study was to determine whether abnormalities of cardiac structure or function ar e present in elderly subjects with borderline isolated systolic hypert ension (defined as systolic blood pressure [BP] between 140 and 159 mm Hg, and diastolic BP < 90 mm Hg). Ninety-one subjects (mean age 77 ye ars) from the original Framingham Heart Study with untreated borderlin e isolated systolic hypertension, who were free of cardiovascular dise ase, were compared with 139 normotensive (BP < 140/90 mm Hg) subjects (mean age 76 years). Measurements included M-mode values for LV struct ure, and 6 Doppler indexes of LV diastolic filling. Subjects with bord erline isolated systolic hypertension and the control group differed i n mean systolic (147 vs 125 mm Hg) and diastolic (76 vs 70 mm Hg) BP. Borderline systolic hypertension was the most frequent form of untreat ed hypertension in this elderly group. The sum of LV wall thicknesses (septum + posterior wall) was significantly higher in borderline hyper tensive subjects than in normotensive ones (20.5 vs 19.7 mm; p = 0.002 ). No difference was detected in LV internal dimension or systolic fun ction. After adjustment for age and other clinical variables, comparis ons between the groups revealed significant differences in indexes of Doppler diastolic filling. Peak velocity of early filling, and the rat io of early to late peak velocities were lower in the hypertensive gro up (40 vs 44 cm/s [p = 0.03] and 0.69 vs 0.76 [p = 0.01], respectively ). Healthy elderly subjects with borderline isolated systolic hyperten sion have similar LV systolic function, mildly increased LV wall thick ness and evidence of impaired Doppler diastolic filling compared with normotensive subjects.