Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension

Background: Left ventricular (LV) hypertrophy and impaired diastolic functi on may occur early in systemic hypertension, but longitudinal studies are m issing. Methods: We performed an echocardiographic follow-up study in young initial ly normotensive male offspring of hypertensive (OHyp) (n = 25) and normoten sive (ONorm) (n = 17) parents. Blood pressure (BP), LV mass, and mitral inf low were determined at baseline and after 5 years. Pulmonary vein flow patt ern assessment and septal myocardial Doppler imaging were additionally perf ormed at follow-up. Results: At follow-up. BP was not significantly different between the two g roups (128 +/- 11 / 84 +/- 10 v, 123 +/- 11 / 81 +/- 5 mm Hg, OHyp v ONorm) but five OHyp had developed mild hypertension. LV mass index remained unch anged and was not different between the two groups at follow-up (92 +/- 17 v 92 +/- 14 g/m(2)). Diastolic echocardiographic properties were similar at baseline, but, at follow-up, the following differences were found: mitral E deceleration time (209 +/- 32 v 185 +/- 36 msec, P<.05) and pulmonary vei n reverse A wave duration(121 +/- 15 v 107 +/- 12 msec, P<.05) were prolong ed in the OHyp as compared to the ONorm. Compared to the normotensive subje cts, the five OHyp who developed hypertension had more pronounced alteratio ns of LV diastolic function, that is, significantly higher mitral A (54 +/- 7 v 44 +/- 9 cm/sec, hypertensives v normotensives, P <.05), lower E/A rat io (1.31 +/- 0.14 v 1.82 +/- 0.48, P <.05), increased systolic-to-diastolic pulmonary vein how ratio (1.11 +/- 0.3 v 0.81 +/- 0.16, P <.005), longer m yocardial isovolumic relaxation time 157 +/- 7 v 46 +/- 12 msec, P<.05) as well as smaller myocardial E (10 +/- 1 v 13 +/- 2 cm/sec, P <.05) and E/A r atio (1.29 +/- 0.25 v 1.78 +/- 0.43, P <.05), despite similar LV mass (91 /- 16 v 93 +/- 18 g/m(2)). Conclusions: Over a 5-year follow-up, initially lean, normotensive, young m en with a moderate genetic risk for hypertension, developed Doppler echocar diographic alterations of LV diastolic function compared to matched offspri ng of normotensive parents. These alterations were more pronounced in the O Hyp who developed mild hypertension and occurred without a distinct rise in LV mass. Am J Hypertens 2001;14:106-113 (C) 2001 American Journal of Hyper tension, Ltd.