ASSOCIATION BETWEEN CENTRAL AORTIC PRESSURE AND LEFT VENTRICULAR CONCENTRIC HYPERTROPHY IN WELL – CONTROLLED HYPERTENSIVE PATIENTS

Abstract

Objective: Arterial hypertension is the most common contributor of cardiac remodeling, but this changes are observed in more advanced stages and uncontrolled hypertension. However little is known about left heart geometry and function in well – controlled hypertension. The aim of the study is to investigate the subclinical abnormalities in middle – aged patients with well – controlled hypertension. Design and method: We studied 45 consecutive middle – aged patients with mild to moderate hypertension and duration up to 5 years and 15 healthy controls. All parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24 h), central pulse pressure (cPP24 h), augmentation index 24 h (Aix24 h) and 24 – hour pulse wave velocity (PWV24 h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA. All patients underwent standard two - dimensional echocardiography with Spackle tracking analysis for left ventricle (LV) and left atrium (LA) global longitudinal strain (GLS). Results: Statistically significant differences in parameters of vascular stiffness were found in patients with hypertension in comparison with healthy controls: cSys24 h (116.64 ± 10.52 vs. 108.4 ± 6.19 mmHg, p < 0.001), cPP24 h (46.57 ± 9.51 vs. 40.4 ± 4.98 mmHg, p = 0.02), PWV24 h (8.48 ± 1.51 vs. 6.29 ± 0.91 m/s, p < 0.0001). The patients with hypertension have concentric LV hypertrophy (p < 0.001), reduced LV GLS (−15.83 ± 3.17 vs. −17.57 ± 2.83, p < 0.001). The hypertension group have higher LV filling pressures, measured by E/e’ ratio (9.84 ± 2.85 vs. 7.62 ± 1.58, p = 0.006), dilated LA (LAVI: 31.86 ± 9.78 vs. 24.96 ± 4.89 ml/m2, p < 0.011) and reduced LA - GLS (29.14 ± 3.90 vs. 41.33 ± 4.37 %, p < 0.0001) in comparison to control group. There is positive correlation between cSys24 h and LV concentric hypertrophy (r = 0.333, p = 0.009) and negative correlation with LA – GLS (r = −0.221, p = 0.09). E/e’ correlated positively with LAVI (r = 0.309, p = 0.016) and negatively with LA–GLS (r = 0.324, p = 0.012). Conclusions: In well - controlled hypertension, central aortic pressure still determine LV concentric hypertrophy. High LV filling pressures determine LA remodeling and dysfunction in middle– aged patients. These results could be used for new direction of central aortic pressure - guided therapy.