EFFECTS OF REDUCED PRELOAD ON DIASTOLIC FILLING IN ESSENTIAL HYPERTENSIVE PATIENTS WITH INCREASED LEFT-VENTRICULAR MASS

Doppler-derived indices of diastolic filling are widely used in the ro utine evaluation of essential hypertensives. However, these indices ar e affected by loading conditions and systolic performance. This study aimed at monitoring the transmitral now pattern and indices of left ve ntricular systolic function during acute nonpharmacological isolated r eduction of preload in essential hypertensives with left ventricular h ypertrophy. Nine essential hypertensive patients with left ventricular hypertrophy and nine age- and sex-matched normotensive controls under went echocardiographic and Doppler evaluation of both systolic functio n and diastolic filling indices at baseline and during lower body suct ion at -40 mm Hg. Lower body suction caused a similar decrease in end- diastolic volume index, stroke volume index, and midwall fractional sh ortening in the normotensives and hypertensives. Circumferential end-s ystolic stress was unaffected in both groups. Acceleration time of ear ly diastolic filling and isovolumic relaxation time increased in the n ormotensives but not in the hypertensives. Deceleration time of early diastolic filling increased in both groups. The ratio of peak velociti es during early filling and at atrial contraction decreased in the nor motensives, whereas it was unchanged in the hypertensives; this was du e to the fact that early filling velocity decreased in both groups, wh ereas peak velocity at atrial contraction decreased only in the hypert ensives. We conclude that Doppler-derived diastolic filling indices ar e not affected by a reduction of preload in essential hypertensives wi th left ventricular hypertrophy. (C) 1997 American Journal of Hyperten sion, Ltd.