Parallel cardiac and vascular adaptation in hypertension.

Abstract

Background. Although vascular damage in the noncoronary circulation is a major cause of complications in hypertension, relatively little is known of the in vivo geometry and function of the arterial circulation in patients with uncomplicated hypertension or of their relation to left ventricular hypertrophy, a marker of enhanced risk of cardiovascular complications.Methods and Results. Wall thickness and internal diameter of the common carotid artery and the presence of atherosclerosis within the extracranial carotid arteries were determined by ultrasound in 43 asymptomatic hypertensive patients and 43 normotensive subjects matched for sex, age, and body size. Vascular stiffness was estimated from simultaneous superimposed carotid pressure waveforms obtained with an external solid-state transducer. Left ventricular size and function were determined echocardiographically. Compared with normal subjects, hypertensive patients had greater left ventricular absolute and relative wall thicknesses, left ventricular mass, and carotid absolute and relative wall thicknesses

Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE substudy

“…Albuminuria may not only reflect glomerular damage but also systemic damage of the small arteries and capillaries, 26,27 whereas high LV mass reflects damage of the heart and probably in the large arteries. [28][29][30] Our results support previous findings by Wachtell et al 3 using electrocardiographic assessment of LV mass. Both UACR and LV mass predicted CV death in patients with history of CV disease indicating that they are not simply markers of preclinical disease and may by themselves increase CV risk.…”

Is inappropriate left ventricular mass related to neurohormonal factors and/or arterial changes in hypertension? a LIFE substudy

“…Based on enddiastolic IMT and lumen diameter, the intimamedia cross-sectional area (IMA) was calculated. 14 The end-diastolic and end-systolic lumen diameters of the right and the left common carotid artery were measured using M-mode within the 1-cm segment proximal to the dilation of the carotid bulb avoiding measuring at plaques (defined as a focal thickness 41.5 mm). For both arteries the relative change in lumen diameter was divided by the brachial pulse pressure at the time of the investigation, and the mean value was used as a measure of carotid distensibility, the so-called pressure strain modulus.…”

Left ventricular concentric remodelling and extracardiac target organ damage in essential hypertension

“…[8][9][10] Furthermore, a close association between LVH and other markers of target organ damage (TOD) has been demonstrated. 11,12 LV concentric remodelling secondary to hypertension is a subtle and early change in cardiac geometry characterised by increased LV relative wall thickness (RWT) with normal overall muscle mass, which seems to be associated with a greater cardiovascular risk than is the normal LV geometry pattern. 13 Since the excess of risk in this altered geometric pattern could be related to the concomitant development of macrovascular and microvascular structural and functional alterations, the present study was specifically designed to evaluate whether in recently diagnosed essential hypertensives the presence of LV concentric remodelling represents the earliest and only change in cardiovascular system or whether the increase in RWT is associated with parallel abnormalities in extracardiac TOD.…”