Prevalence of cardiac structural and functional abnormalities in untreated primary hypertension.

Abstract

We examined the prevalence of left ventricular structural and functional abnormalities in previously untreated subjects by performing echocardiography in 89 normal volunteers, 57 patients with established hypertension, and 38 patients with mild or borderline hypertension. We measured left ventricular mass, wall thickness, internal diameter, and wall thickness/radius ratio. Because of intergroup differences hi body size, we used covariance analysis to index these variables to a common value of 1.8 m 2. No adjustment was needed for the wall thickness/radius ratio. Functional variables determined were fractional shortening and transmitral early/late flow velocity ratio (the latter was standardized by analysis of covariance to age 40 years). The prevalence of left ventricular mass index values more than 2 SD above the mean of the normal group was 30% in the patients with established hypertension and 12-15% hi the patients with mild hypertension. Corresponding figures for wall thickness index were 65% and 32% and for the wall thickness/radius ratio 60% and 40%. The prevalence of abnormality in the transmitral flow velocity was 28% in the patients with established hypertension and 12% in the patients with mild hypertension. A multivariate discriminant function that used combined anatomic and functional variables provided the most reliable classification; it was correct in 82% of normal subjects, 65% of patients with established hypertension, and 61% of patients with mild hypertension. The majority of patients with hypertension have cardiac structural or functional abnormalities, or both. {Hypertension 1989; 13:151-162) I n human primary hypertension the reported prevalence of left ventricular hypertrophy (LVH) ranges between 20 and 80%. >-7 The majority of investigators suggest that the prevalence is closer to the lower end of this range. However, even the upper end of the range is below the almost universal prevalence of LVH in animals with genetic or experimental hypertension. -9 Hypertension is usually more severe in the experimental models, which could account for the greater incidence of LVH. In addition, most experiments are performed in inbred strains of animals, where the normal range of variation of left ventricular size may be smaller than in a mixed population 89 where genetic or environmental factors are not as well controlled. Many of the previous human series have included patients previously treated with antihyper-

Hypertension and the heart

“…In contrast, LV hypertrophy is found in 12-30% of unselected hypertensive adults by echocardiography. [10][11][12] Although LV hypertrophy is not present in all hypertensive patients, its prevalence may exceed 90% among patients with sustained severe or malignant hypertension 13,14 as opposed to only 10% of patients with new onset of malignant hypertension or pre-eclampsia. 14,15 Coexisting obesity has been shown to increase the prevalence of hypertensive LV hypertrophy by 1.5-to 2-fold.…”

Prospective Study of the Changes in Left Ventricular Mass and Geometry Patterns in Hypertensive Patients During 5 Years of Follow-up

“…12,13 Thus, concentric LVH is associated with a higher risk of cardiac arrhythmias, and even sudden death, 12 and the literature is replete with evidence that concentric LVH strongly predicts the development of heart failure. 13,14 In addition, the evidence is accumulating that eccentric LVH is frequently observed in the early stages of hypertension, [15][16][17] but little is known whether the geometry patterns are necessary consequent stages in the development of the hypertensive heart from normal geometry through LVH to LV dilatation and heart failure, or if every pattern is genetically and/or hemodynamically predisposed. Finally, the natural history of the transition from 1 pattern to another is still unknown, as are the changes in the geometry patterns during antihypertensive therapy.…”

Population impact of losartan use on stroke in the European Union (EU): Projections from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study

“…The prevalence of LVH was varied from a low of 9% (from a Spanish study of mild hypertensive patients, average age of 49 years, treated in primary care) 29 to a high of 40% (based on the average value of studies reporting echocardiogram-diagnosed LVH). 30,[34][35][36][37][38][39][40] Heart failure prevalence was evaluated by increasing and decreasing the baseline heart failure prevalence (21.0 and 23.1% for male patients and female patients) by 50%. The stroke cumulative incidence difference was based on the upper and lower boundary of the 95% confidence interval for the parameter (0.6 and 2.6%).…”