Cardiac structure and function and arterial circulation in hypertensive patients with and without metabolic syndrome

Ferrara, L; Guida, L.; Ferrara, F; Luca, G De; Staiano, Laura; Celentano, Aldo; Mancini, Mario

doi:10.1038/sj.jhh.1002222

Cited by 17 publications

(16 citation statements)

References 35 publications

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“…The observation of an early dysfunction of the diastolic ventricular filling is, however, one of the first findings of such abnormality in subjects with MS observed in a population sample, confirming data detected in the American Indian population. 24 In patients from the Hypertension Outpatient Clinic, the corresponding data are, however, conflicting since differences in diastolic function between subjects with and without MS were present in a study 25 and absent in another, 22 possibly because differences were obscured by the equally elevated BP values in both groups. Regarding the possible phenomenon of the pseudo-normalization of the E/A ratio, which occurs in subjects with particularly deteriorated diastolic function, it does not appear to influence the results of the present study since it should have played against our observation of a reduced E/A.…”

Section: H Ig H B Lo O D P R E S S U R E H Ig H F a S T In G B G L O mentioning

confidence: 99%

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Ferrara

Cardoni²,

Mancini

et al. 2007

J Hum Hypertens

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Aims of this study were to investigate the prevalence of metabolic syndrome (MS), diagnosed according to the International Diabetes Federation (IDF) criteria and its relationship with echocardiographic parameters of cardiac structure and function. The study was performed in 707 subjects, age 45-54 years, of the Gubbio Population Study who underwent a comprehensive examination including measurement of body size, blood pressure (BP) and heart rate, 12-lead electrocardiogram, Doppler echocardiography, standardized blood and urine laboratory tests. One hundred and fifty-three subjects were found to have MS, which was more frequent among hypertensive patients than normotensive controls (36.2 vs 13.7%, Po0.001). Apart from visceral obesity present in all subjects by definition according to the IDF criteria, high levels of BP (4130/85 mm Hg) and triglycerides (X150 mg/dl) were the most frequently observed components of the syndrome, since their prevalence averaged 75% of those with the syndrome. Left ventricular mass (95.6722 vs 86.4722 g/m 2 ; Po0.001) and prevalence of left ventricular hypertrophy were increased in the subgroup with MS. Waist circumference, BP and blood glucose were the components of the syndrome with stronger impact on cardiac mass. An early impairment of the diastolic function was detected in this subgroup with a reduction of the early-to-late diastolic filling (0.9170.17 vs 0.9970.23, Po0.001). The results of the present study indicate that MS is frequent in middleaged general population, particularly in subjects with arterial hypertension. The syndrome is associated to the increase in ventricular mass and the early impairment of diastolic function.

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Section: H Ig H B Lo O D P R E S S U R E H Ig H F a S T In G B G L O mentioning

confidence: 99%

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Ferrara

Cardoni²,

Mancini

et al. 2007

J Hum Hypertens

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“…Previous reports have shown that MetS is associated with elevated LVM, 6,7,12,[16][17][18][19][20][21][22][23][24][25] but the potential influence of gender on MetS-related LVH is controversial. 6,17,24,25 In a study conducted on 618 hypertensive patients a remarkable sex difference in the association between MetS and LVH was found; indeed, in that study, MetS was a strong determinant of LVM in women beyond the influence of body size and haemodynamic variables, whereas the relation was weaker and fully explained by the effect of confounding factors in men.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Subjects with left ventricular mass (LVM) in the upper normal range already have increased risk for CV events. 15 MetS has been associated with an increased LVM in recent reports conducted in hypertensive patients and in general population, 6,7,12,[16][17][18][19][20][21][22][23][24][25] independently of various confounding factors, such as BP values and age. However, only in a few of these studies the impact of MetS on LVM was separately analysed by gender, with conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Relationships between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter?

et al. 2008

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Several studies documented an association between metabolic syndrome (MetS) and left ventricular (LV) hypertrophy. However, only in a few of these studies the impact of MetS on left ventricular mass (LVM) was separately analysed by gender, with conflicting results. The aim of our study was to verify, in a wide sample of essential hypertensive patients, the influence of gender, if any, on the relationship between MetS and LVM. We enrolled 475 non-diabetic subjects (mean age: 46 ± 11 years), with mild-to-moderate essential hypertension, of whom 40% had MetS, defined on the basis of Adult Treatment Panel III (ATPIII) criteria. All the patients underwent a 24-h ambulatory blood pressure monitoring and an echocardiogram. LVM indexed for height 2.7 (LVMH 2.7 ) was significantly (Po0.001) higher in women with MetS (n ¼ 83) than in those without it (n ¼ 97; 54 ± 17 vs 42±11 g m À2.7). An equally significant difference in LVMH 2.7 was documented also in male gender between the two groups with (n ¼ 105) and without MetS (n ¼ 190; 51 ± 14 vs 43±11 g m À2.7 ; Po0.001). The relationship between MetS and LVMH 2.7 remained statistically significant (Po0.001) in both sexes, in multiple regression analyses, even after adjustment for potential confounding factors. Our results seem to suggest that the relationship between MetS and LVM is not significantly affected by gender, being LVM increased in both hypertensive women and men with MetS.

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“…Earlier studies have shown that hypertensive patients with MS are more susceptible to develop LVH than those without MS. [7][8][9][10] Mule et al 9 showed in 475 non-diabetic subjects with mild-to-moderate essential hypertension, of whom 40% had MS, that left ventricular mass was significantly higher in those with MS than in those without it. The relationship between MS and left ventricular mass was not affected by gender.…”

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confidence: 99%

Metabolic syndrome and biventricular hypertrophy in essential hypertension

Grossman

2008

J Hum Hypertens

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Long-standing hypertension is associated with left ventricular hypertrophy (LVH) that may be either concentric or eccentric. It has been shown that hypertension is also associated with hypertrophy and fibrosis of the right ventricle. 1 The hypertrophy of the right ventricle is not because of pressure overload, and therefore non-haemodynamic factors, such as angiotensin II, aldosterone, insulin, the sympathetic nervous system and endothelin may be involved in this process.The contribution of non-haemodynamic factors to the development of cardiac hypertrophy may also explain why in several studies it has been shown that the increase in left ventricular mass preceded hypertension. For example, we followed 500 young healthy Israeli air force aviators, who underwent echocardiography at the start of their military service for an average period of 7.5 ± 3.0 years. 2 We showed that interventricular septal thickness predicted the development of systolic hypertension suggesting that interventricular septum thickening is not merely a result of long-term elevation of blood pressure. These results suggest that LVH is an early marker of hypertension and is caused by non-haemodynamic factors that are also responsible for hypertension, such as over activity of the sympathetic nervous system or the renin-angiotensin system. Heart muscle may be more sensitive than blood pressure to the activation of these systems, and heart muscle changes appear earlier than the elevation in blood pressure.Left ventricular hypertrophy is an independent risk factor for cardiovascular (CV) disease. 3 Hypertensive cardiomyopathy is associated with impaired cardiac diastolic and systolic functions. 4 In hypertensive patients, contractility deteriorates as left ventricular mass increases. 5 Diabetes mellitus accelerates the development of LVH in patients with essential hypertension independent of arterial pressure. 4 In this issue of the Journal of Human Hypertension, Cuspidi et al. 6 show that metabolic syndrome (MS) also accelerates the development of LVH, as hypertensive patients of both genders had more cardiac alterations when they have MS.Earlier studies have shown that hypertensive patients with MS are more susceptible to develop LVH than those without MS. 7-10 Mule et al. 9 showed in 475 non-diabetic subjects with mild-to-moderate essential hypertension, of whom 40% had MS, that left ventricular mass was significantly higher in those with MS than in those without it. The relationship between MS and left ventricular mass was not affected by gender. An additional study by Mule et al. 10 showed that MS may have a deleterious influence on left ventricular structure and function even in white coat hypertension.The deleterious effect of MS on the left ventricle is well established; however data regarding the effect of MS on the development of right ventricular hypertrophy are lacking. Indeed, the study by Cuspidi et al. 6 shows that MS accelerates, in hypertensive patients, the development of right ventricular hypertrophy and diastolic dysfunction ...

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Cardiac structure and function and arterial circulation in hypertensive patients with and without metabolic syndrome

Cited by 17 publications

References 35 publications

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Metabolic syndrome and left ventricular hypertrophy in a general population. Results from the Gubbio Study

Relationships between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter?

Metabolic syndrome and biventricular hypertrophy in essential hypertension

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