Metabolic syndrome and biventricular hypertrophy in essential hypertension

Abstract

The metabolic syndrome (MS) is associated with structural and functional alterations of the left ventricle (LV); no evidence is available on the impact of the MS on the right ventricle (RV). To assess whether MS, as defined by the ATP III report, is associated with biventricular hypertrophy, a total of 286 hypertensive subjects (mean age 58.7±12.2 years) attending our outpatient clinic underwent the following procedures: (1) physical examination and standard clinic blood pressure (BP) measurement; (2) routine laboratory investigations; (3) M-mode, two-dimensional and Doppler echocardiography. LV hypertrophy (LVH) was defined by LM mass index X51/47 g m À2.7 in men and women, respectively. Right-sided chambers were measured in parasternal long axis at the outflow tract and subcostal view; RV hypertrophy (RVH) was defined by anterior RV wall thickness X6.0/5.5 mm in men and women, respectively. Filling velocities of both ventricles were assessed by pulsed Doppler echocardiography. Structural cardiac alterations were more pronounced in hypertensive men and women with MS than in their non-MS counterparts and involved both ventricles as shown by the differences in continuous variables as well as in prevalence rates of LVH (58 and 48% vs 28 and 30%, respectively, Po0.01) and RVH (48 and 54% vs 25 and 35%, respectively, Po0.01). Both LV and RV filling in MS hypertensives were more dependent on the atrial systole. Our study shows that in human hypertension, structural and functional cardiac changes induced by MS are not limited to the LV but also involve the right one.

Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy

“…Hypertensive and obese patients have a twofold risk of developing LVH 4 .Cuspidi [33] showed that obesity nearly doubled the risk of biventricular hypertrophy; while Ärnlöv [34] found it as the main risk factor among the components of the metabolic syndrome for cardiovascular diseases.…”

Metabolic syndrome and biventricular hypertrophy in essential hypertension

“…However, routine echocardiography that is performed in hypertensive patients does not necessarily evaluate the right chambers. The findings of the study by Cuspidi et al 6 would suggest that the evaluation of the right side of the heart is worthwhile and should be recommended. This would clearly help improve the clinical assessment and management of human hypertension.…”

“…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.…”

“…Indeed, the study by Cuspidi et al 6 shows that MS accelerates, in hypertensive patients, the development of right ventricular hypertrophy and diastolic dysfunction of the right ventricle. 6 Nonetheless, the MS is a clustering of some CV risk factors in one subject. The core components of MS include impaired glucose metabolism, obesity, dyslipidaemia and hypertension.…”

“…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.…”