Relation of left ventricular geometry and function to systemic hemodynamics in hypertension: The LIFE Study

Objectives To clarify the relations of systemic hemodynamics to left ventri cular (LV) geometric patterns in patients with moderate hypertension and ta rget organ damage. Background LV geometry stratifies risk in hypertension, but relations of LV geometry to systemic hemodynamic patterns in moderately severe hypertensio n have not been fully elucidated. Design Cross-sectional case-control study . Setting Baseline findings in the echocardiographic substudy of the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE) and in a normotensive reference group. Patients/participants Nine hundred and sixty-four patients with Stage I-III hypertension and LV hypertrophy by Cornell voltage duration criteria ((SV3 + RaVL [+ 6 mm in women]) x QRS > 2440 mm x ms) or modified Sokolow-Lyon v oltage criteria (SV1 + RV5/RV6 > 38 mm), and 366 apparently normal adults. Interventions None. Methods Two-dimensional and Doppler echocardiograms were used to classify h ypertensive patients into groups with normal geometry, concentric remodelli ng and concentric and eccentric hypertrophy, and to measure stroke volume ( SV), cardiac output, peripheral resistance and pulse pressure/SV as a measu re of arterial stiffness. Comparisons were adjusted for covariates by gener al linear model with the Sidak post-hoc test, Results Mean SV was higher in patients with eccentric hypertrophy (83 ml/be at) and lower with concentric remodeling (68 ml/beat) than in normal adults (73 ml/beat). Cardiac output was highest in patients with eccentric LV hyp ertrophy and lower with concentric remodeling than eccentric hypertrophy; m ean pressure and peripheral resistance were equally high in all hypertensiv e subgroups, whereas pulse pressure/SV was most elevated (by a mean of 47% versus reference subjects) with concentric remodeling and least so (mean 15%) with eccentric hypertrophy. In multivariate analysis (Multiple R + 0.6 8), LV mass was independently related to higher systolic pressure, older ag e, SV, male gender and body mass index (all P < 0.001), Relative wall thick ness was independently related (Multiple R + 0.50) to older age, higher sys tolic pressure, lower SV (all P < 0.001) and higher body mass index (P + 0. 007), SV and cardiac output were lower in patients with low stress-correcte d midwall shortening. Conclusion In patients with moderate hypertension and ECG LV hypertrophy, t he levels of SV and pulse pressure/SV, are associated with, and may be stim uli to different LV geometric phenotypes. (C) 2001 Lippincott Williams & Wi lkins.