The hemodynamics in labile hypertension

Eich, Robert H.; Peters, R.; Cuddy, Richard P.; Smulyan, Harold; Lyons, Richard H.

doi:10.1016/0002-8703(62)90195-3

Cited by 172 publications

(33 citation statements)

References 8 publications

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“…18,19 In actuality, patients with borderline hypertension may have elevated, normal, or reduced cardiac output, and with advancing age, the cardiac output declines in these patients. 20 Recently, a number of studies showed that individuals with borderline hypertension, even in the adolescent age range, may have a relative enlargement of the left ventricle as compared with normotensive patients.…”

Section: Discussionmentioning

confidence: 99%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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Abstract-We recently showed that rarefaction of skin capillaries in the dorsum of the fingers of patients with essential hypertension is due to the structural (anatomic) absence of capillaries rather than functional nonperfusion. It is not known whether this rarefaction is primary (ie, antedates the onset of hypertension) or secondary (ie, as a consequence of sustained and prolonged elevation of blood pressure [BP]). The aim of the present investigation was to study skin capillary density in a group of patients with mild borderline hypertension to assess whether rarefaction antedates the onset of sustained elevation of BP. The study group included 18 patients with mild borderline hypertension (mean supine BP, 136/83 mm Hg), 32 normotensive controls (mean BP, 126/77 mm Hg), and 45 patients with established essential hypertension (mean BP, 156/98 mm Hg). The skin of the dorsum of the fingers was examined by intravital capillary videomicroscopy before and after venous congestion at 60 mm Hg for 2 minutes. Patients with borderline essential hypertension had the lowest resting capillary density when compared with normotensive controls and patients with established hypertension. Maximal capillary density with venous congestion in the borderline group remained the lowest. The study confirmed that patients with borderline essential hypertension have skin capillary densities that are equally low as or even lower than patients with established hypertension. Both groups had significantly lower capillary densities than normal controls. One explanation for the results is that capillary rarefaction may be due to an early structural abnormality in essential hypertension. (Hypertension. 1999;34:655-658.)

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Section: Discussionmentioning

confidence: 99%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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“…However, school children without cardiac disease are optimal subjects for echocardiographic estimation of cardiac output. Meyer et al 11 have pointed out that the cineangiographic left ventricular long axis in normal children shortens 6% during systole, while the minor axis shortens an average of 21%. Thus, the major determinant of stroke volume is the change in the minor axis.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular hypertrophy in children with blood pressures in the upper quintile of the distribution. The Muscatine Study.

Schieken¹,

Clarke²,

Lauer³

1981

Hypertension

125

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SUMMARY From echocardlographic measurements of left heart dimensions, cardiac output was estimated in 264 school children whose systolic blood pressure persisted in the lowest, middle, or highest quintile of the distribution for their age and sex. Children with blood pressure in the upper quintile were taller, heavier, and more obese. Echocardiographically determined left ventricular wall mass, corrected for body size, was significantly greater in these children than those in the lower quintiles of blood pressure. These children dis-

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“…Much of the discrepancy among these reports may be due to examination of subjects with different severities of hypertension. Data from available longitudinal studies 10,13,14,37,46 suggest that, on average, progression from mild to moderate to severe hypertension is paralleled by evolution of the hemodynamic profile from increased cardiac index with normal peripheral resistance to normal cardiac index with increased resistance to decreased cardiac index with markedly increased resistance. Vascular stiffness has not been considered in these studies, yet a steady increase with age in both normal and hypertensive patients has been well described.…”

Section: Slotwiner Et Al Age and Ventricular Function In Hypertensionmentioning

confidence: 99%

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

et al. 2001

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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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The hemodynamics in labile hypertension

Cited by 172 publications

References 8 publications

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

Left ventricular hypertrophy in children with blood pressures in the upper quintile of the distribution. The Muscatine Study.

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

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