Relationship between left ventricular hypertrophy, hypertensive retinopathy, microalbuminuria and echocardiographic modalities in newly diagnosed hypertensive patients

Abstract

Longitudinal myocardial function (LMF) may be impaired while systolic function is still normal. We investigated relationship between LMF and hypertensive organ damage in newly diagnosed stage I hypertensive patients. A total of 57 patient with never treated stage I hypertension and 48 matched healthy control subject were enrolled in the study. Conventional 2-D, Doppler and tissue wave Doppler imaging (TDI) echocardiography were used. LMF was evaluated by the septal and lateral strain (S) and strain rate (SR) measurements. Hypertensive complications were evaluated by the urine microalbumin levels and retinal examination. A multivariate regression analysis was perfomed to assess the relation between the variables. Ejection fraction, mid-wall fractional shortenning, systolic movement rates (TDs) in TDI were similar both in hypertensive and control groups. In patients with left ventricular hypertrophy, septal TDs (7.29 +/- 1.28 vs. 8.06 +/- 1.19 cm, P = 0.03), lateral TDs (8.46 +/- 1.83 vs. 9.87 +/- 2.42 cm, P = 0.01) and lateral S (-13.02 +/- 7.83 vs. -18.86 +/- 8.60%, P = 0.01) values were significantly lower. Septal S (-13.67 +/- 3.52 vs. -19.09 +/- 5.96%, P < 0.01) and SR (-0.83 +/- 0.29 vs. -1.22 +/- 0.28 1/S, P < 0.01) were significantly decreased in hypertensive patients with microalbuminuria. Septal S value was also significantly decreased in patients with retinopathy (-14.76 +/- 5.55 vs. -20.20 +/- 5.44%, P = 0.01). Multivariate analysis showed that only septal and lateral S values were independent factors for the retinopathy and left ventricular hypertrophy, respectively. In hypertensive patients, LMF established by the measurement of S and SR, might be impaired and also related with end organ damage while global circumferential function is preserved.

Hypertensive retinopathy and its association with cardiovascular, renal and cerebrovascular morbidity in Congolese patients : cardiovascular topic

“…Signs of hypertensive retinopathy have also long been recognised as risk indicators of LVH, both in population- and hospital-based studies 24-26. For example, in the Chronic Renal Insufficiency Cohort (CRIC) study,26 there was an association between severity of hypertensive retinopathy and the incidence of any cardiovascular disease.…”

Association of Low-Grade Albuminuria With Adverse Cardiac Mechanics

“…12 Similarly, another TDI-based study of 57 hypertensives and 48 healthy matched controls showed an association of septal strain and strain rate with the presence of microalbuminuria, but did not analyze the relationship across a range albuminuria levels. 11 …”

“…9, 10 However, the relationship between albuminuria and subclinical myocardial dysfunction, prior to development of ventricular remodeling or overt HF, is not well understood, and has only been directly evaluated in small, selected samples. 11, 12 …”

Cardiovascular imaging 2010 in the International Journal of Cardiovascular Imaging

“…In patients with arterial hypertension, longitudinal myocardial function may be impaired while systolic function is still normal. Bilge et al [12] investigated the relationship between longitudinal myocardial function (by measuring septal and lateral TDI derived strain and strain rate) in 57 patients with untreated stage I hypertension and 48 matched healthy controls. In hypertensive patients longitudinal myocardial function was impaired and related with end organ damage (microalbuminuria, retinopathy) while global circumferential function was still preserved.…”