COMPARISON IN SYSTEMIC HYPERTENSION OF LEFT-VENTRICULAR MASS AND GEOMETRY WITH SYSTOLIC AND DIASTOLIC FUNCTION IN PATIENTS LESS-THAN-65 TO GREATER-THAN-OR-EQUAL-TO-65 YEARS OF AGE

Previous studies have differed on the independent effect of age and ge nder to left ventricular (LV) mass. Data on ventricular remodeling in hypertensive patients greater than or equal to 65 years of age is lack ing. Similarly, the systolic and diastolic interaction in older hypert ensives is not well defined. In a prospective study, we examined the r elation of LV mass, relative wall thickness, and systolic and diastoli c interaction in 508 hypertensive patients between 50 and 80 years of age who were divided according to age (less than 65 and greater than o r equal to 65 years) and gender. LV mass, geometric classification, sy stolic wall stress, and Doppler filling were obtained according to sta ndard Doppler echocardiographic criteria. In men, most measurements we re similarly distributed. However, women greater than or equal to 65 y ears of age had smaller LV systolic dimensions, thicker ventricular se ptums, higher endocardial and midwall fractional shortenings, and lowe r end-systolic wall stress. Although LV mass was higher in men, there was no age difference within the same sex. The most common LV geometri c remodeling was increased relative wall thickness in the form of conc entric hypertrophy or concentric remodeled. The predominant mitral flo w pattern was ''impaired relaxation''; however, older patients had eve n shorter E waves, taller A waves, and lower E/A ratios. Thus, patient s greater than or equal to 65 years of age had an even higher prevalen ce of this pattern (men, 89% vs 73%, p less than 0.001, and women, 91% vs 77%, p less than 0.001). Delayed LV relaxation with preservation o f systolic ejection indexes is an early abnormality in essential hyper tension, which lasts an undetermined rime with further progression as patients aged. As a result, hypertensive patients greater than or equa l to 65 years of age had the most pronounced structural and functional changes, an observation particularly noted in women. In those greater than or equal to 65 years, data from the Doppler E wave and A wave do not distinguish the physiologic process of aging from the pathologic changes of pressure overload. (C) 1998 by Excerpta Medica, Inc.