Vascular changes in hypertensive patients with different left ventricular geometry

Sd, Pierdomenico; Lapenna, Domenico; Guglielmi,; Porreca, Ettore; Antidormi, Teresa; Cuccurullo, Franco; Mezzetti, Andrea

doi:10.1097/00004872-199512010-00035

Cited by 23 publications

(13 citation statements)

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“…Only a limited number of studies have been addressed to specifically compare the extent of extracardiac TOD in never-treated essential hypertensive patients with LV concentric remodelling and normal LV geometry. Pierdomenico et al 31 found that IMT of carotid arteries was significantly lower in hypertensive subjects with normal LV geometry than in those with LV concentric remodelling. This difference, however, may be explained by the lower ambulatory BP and LV mass index values in hypertensive subjects with normal LV geometry.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2002

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Left ventricular (LV) concentric remodelling is an adaptive change in cardiac geometry frequently observed in arterial hypertension. This study was addressed to investigate the extent of extracardiac target organ damage (TOD) in patients with LV concentric remodelling. Two groups of never-treated essential hypertensives, 31 with normal LV geometry (group I, relative wall thickness: 0.39) and 31 with LV concentric remodelling (group II, relative wall thickness: 0.47) matched for age, sex, body mass index and mean 24-h systolic blood pressure (BP), were included in the study. They underwent clinical and laboratory examination, 24-h ambulatory BP monitoring (ABPM), 24-h urinary collection for microalbuminuria, non-mydriatic photography of ocular fundi, echocardiography and carotid ultrasonography. In both groups age (I: 51 ؎ 11 years; II: 51 ؎ 11

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Section: Discussionmentioning

confidence: 98%

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

et al. 2002

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“…Few studies have demonstrated an increase in the prevalence of retinopathy grades III and IV 34 or in the forearm minimal vascular resistance 33 in patients with concentric geometry. We have recently provided additional explanation by demonstrating the presence of concomitant vascular damage in small resistance arteries of patients with concentric hypertrophy and remodeling 35 that could justify a more severe impairment of coronary vasodilator reserve and possibly of cerebral perfusion.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Concentric Geometry During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

et al. 2004

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Abstract-Left ventricular (LV) mass and geometry predict risk for cardiovascular events in hypertension. Regression of LV hypertrophy (LVH) may imply an important prognostic significance. The relation between changes in LV geometry during antihypertensive treatment and subsequent prognosis has not yet been determined. A total of 436 prospectively identified uncomplicated hypertensive subjects with a baseline and follow-up echocardiogram (last examination 72Ϯ38 months apart) were followed for an additional 42Ϯ16 months. Their family doctor gave antihypertensive treatment. After the last follow-up echocardiogram, a first cardiovascular event occurred in 71 patients. Persistence of LVH from baseline to follow-up was confirmed as an independent predictor of cardiovascular events. Cardiovascular morbidity and mortality were significantly greater in patients with concentric (relative wall thickness Ն0.44) than in those with eccentric geometry (relative wall thickness Ͻ0.44) in patients presenting with LVH (Pϭ0.002) and in those without LVH (Pϭ0.002) at the follow-up echocardiogram. The incidence of cardiovascular events progressively increased from the first to the third tertile of LV mass index at follow-up (partition values 91 and 117 g/m 2 ), but for a similar value of LV mass index it was significantly greater in those with concentric geometry (OR: 4.07; 95% CI: 1.49 to 11.14; Pϭ0.004 in the second tertile; OR: 3.45; 95% CI: 1.62 to 7.32; Pϭ0.001 in the third tertile; PϽ0.0001 in concentric versus eccentric geometry). Persistence or development of concentric geometry during follow-up may have additional prognostic significance in hypertensive patients with and without LVH.

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“…11, 13 Roman et al 14 studied carotid artery structure and function in the same 4 left ventricular phenotypes. They found that although blood pressure was the same in the concentric and eccentric hypertrophy groups, carotid artery dimensions, intima-media thickness, and stiffness were most abnormal in the concentric hypertrophy group.…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Contribution of Cardiac and Arterial Remodeling to Hypertension

2000

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Abstract-The study aim was to quantify the individual and combined contributions of both the arterial system and the heart to systolic blood pressure in hypertension. We assessed the parameters of a heart-arterial model for normotensive control subjects and hypertensive patients with left ventricular adaptation patterns classified as normal, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy. The present simulations show that vascular stiffening alone increases the pulse pressure without increasing systolic blood pressure. It is only in combination with an increased peripheral resistance that arterial stiffening leads to systolic hypertension in concentric remodeling and concentric hypertrophy. The contribution of cardiac pump function to the increase in blood pressure depends on cardiac remodeling, hypertrophy, or both. In hypertensive patients with a normal left ventricle, the heart is responsible for 55% of the increase in systolic blood pressure. In concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, the cardiac contribution to the increase in systolic blood pressure is 21%, 65%, and 108%, respectively. We conclude that along with arterial changes, cardiac remodeling and hypertrophy contribute to hypertension. ) and contractile properties of the heart muscle (LV contractility). The 2 main mechanical afterload parameters that determine systolic blood (SBP) and pulse pressure (PP) are total peripheral resistance (R) and total arterial compliance (C). 1,2 Arterial blood pressure is thus determined by a limited number of cardiac and arterial mechanical factors. In hypertension, each of these parameters may change and thus contribute, to a different degree, to the elevated blood pressure.Blood pressure in hypertension, measured in vivo, reflects the combined effects of alterations in cardiac and arterial parameters. In this work, we use a mathematical heart-arterial interaction model 1 to unravel and quantify the specific contribution of arterial and cardiac changes. Cardiac and arterial model parameters for normotensive control subjects and for hypertensive patients with different LV adaptation patterns were taken directly from the literature or calculated from data given in the literature. 3 The effect of individual changes in arterial and cardiac properties in hypertension was evaluated, and the relative contribution of cardiac and arterial remodeling to the increase in SBP was quantitatively assessed. Methods Heart-Arterial Interaction ModelAortic blood pressure is computed with a heart-arterial interaction model 1 (Figure 1). Heart function is described with a time-varying elastance model 4 and is coupled to a 4-element lumped-parameter windkessel model that represents the arterial load. 5 The systemic arterial model parameters are total peripheral resistance (R), total arterial compliance (C), total inertance (L), and aortic characteristic impedance (Z 0 ). Time-varying elastance is calculated as E(t)ϭP LV / (V LV ϪV d ), where P LV and V LV are LV pressure and vol...

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Vascular changes in hypertensive patients with different left ventricular geometry

Cited by 23 publications

References 0 publications

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

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

Left Ventricular Concentric Geometry During Treatment Adversely Affects Cardiovascular Prognosis in Hypertensive Patients

Quantification of the Contribution of Cardiac and Arterial Remodeling to Hypertension

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