Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension

Abstract

Abstract-Previous studies in normotensive subjects have shown a slight decline in resting left ventricular pump function and midwall contractility with aging. We examined the relations of age to these variables and to peripheral resistance and vascular stiffness in 272 asymptomatic, unmedicated adults (25 to 80 years old) who had uncomplicated essential hypertension. Cardiac and carotid ultrasound and carotid pressure waveforms were obtained to measure left ventricular dimensions, endocardial and midwall left ventricular shortening, stroke index and cardiac index, end-systolic stress, and pulse pressure/stroke index and ␤, pressure-dependent and independent measures of vascular stiffness, respectively. Endocardial and midwall stress-corrected left ventricular shortening assessed ventricular performance. Cardiac index and TPRI did not change with age in either gender, with age-related increases in systolic pressure offset by increasingly concentric ventricular geometry in women and enhanced ventricular systolic function in men. In contrast to the lack of age-related change in traditional hemodynamic indexes, pulse pressure/stroke volume and ␤ strongly increased with age (PϽ0.001). Thus, in uncomplicated, relatively mild essential hypertension, neither cardiac index nor peripheral resistance is associated with age. This hemodynamic stability is associated with age-related increased concentricity of ventricular geometry in women and increased ventricular performance indexes in hypertensive men. Vascular stiffness progressively increases with age, independent of change in mean pressure or resistance, possibly contributing to increased rates of cardiovascular events in older individuals. Key Words: hypertension, mild Ⅲ echocardiography Ⅲ age Ⅲ ventricular function Ⅲ myocardium A dvancing age, increased left ventricular (LV) mass, and midwall but not endocardial fractional shortening have been shown to predict morbidity and mortality in hypertensive patients. 1-7 Although reduced cardiac output and dysfunction of average myocardial fibers located at the LV midwall occur commonly in hypertension, it is not clear at what stage in the disease these changes develop. 8,9 Previous cross-sectional and some longitudinal studies in hypertensive subjects have demonstrated elevated resting cardiac output (attributed to increased heart rate and/or stroke volume) in young, mildly hypertensive individuals. 10 -12 In contrast, low levels of invasively determined cardiac output and stroke index have been reported in older, often more severely hypertensive individuals. 11,13,14 Nevertheless, uncertainty regarding the evolution of hemodynamic alterations persists. 15 Results from invasive hemodynamic studies may be affected by an "alerting" response that may be greater at younger than older ages. Additionally, previous echocardiographic studies have used endocardial rather than midwall shortening to estimate LV function, thus measuring LV chamber performance accurately but tending to overestimate myocardial function in thick-walled he...

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