Early signs of cardiac involvement in hypertension

Background Whether abnormalities of diastolic function are the earliest car diac change in hypertension is still a matter for dispute. The aim of this study was to assess whether left ventricular diastolic dysfunction is an ea rly sign of cardiac involvement in hypertension. Methods In 578 young patients with stage I hypertension from. the Hypertens ion and Ambulatory Recording Venetia Study (HARVEST) and 101 normotensive c ontrol patients echocardiographic Doppler examination and ambulatory blood pressure monitoring were performed. Results Left ventricular mass, wall thickness, and relative wall thickness, adjusted for confounders, were greater in the hypertensive than in the nor motensive patients (all P < .0001). After adjustment for confounders, the A -wave peak velocity was higher in the hypertensive patients (51.5 <plus/min us> 11.5 vs 43.4 +/- 8 cm/s, P < .001) as were A-wave velocity time integra l (5.6 <plus/minus> 1.7 vs 4.6 +/- 1.3 cm, P = .01), total area (16.9 +/- 4 .4 vs 15.6 +/- 3.1 cm, P = .04), and E-wave peak velocity (69.9 +/- 15.2 vs 67.5 +/- 13.3 cm/s, P = .03). All indexes of diastolic function were simil ar in the hypertensive subjects subdivided according to whether they had "w hite-coat" or sustained hypertension. Among the hypertensive subjects,age a nd heart rate were the strongest predictors of diastolic indexes, whereas a mbulatory blood pressure explained only a marginal part of the E/A ratio, A -wave peak velocity, and the first one third total area ratio (P = .04, P = .02, and P = .05, respectively). Left ventricular mass and wall thickness were not associated with any Doppler index. When a clustering of diastolic indexes (E/A wave ratio, deceleration time, first one third of diastole, an d peak E-wave-velocity) was used to identify subjects with diastolic dysfun ction, no significant differences in either clinic or ambulatory blood pres sure were observed between the group with diastolic dysfunction and the gro up with normal function. Conclusions We conclude that the earliest signs of cardiac involvement in h ypertension are left ventricular structural abnormalities. Left ventricular diastolic function is only marginally affected, even when multiple paramet ers of left ventricular filling are taken into account.