Left ventricular diastolic filling alterations in normotensive young adults with a family history of systemic hypertension

Abstract

To characterize the cardiovascular consequences of a history of hypertension in first-degree relatives in normotensive young adults, 72 normotensive (diastolic blood pressure [BP] < 90 mm Hg) healthy volunteers (age 18 to 30 years) were studied with 2 dimensionally guided M-mode echocardiography, pulsed Doppler echocardiography, and 2-hour automated BP monitoring. Of the 72 subjects, 19 (12 men and 7 women) had a family history of hypertension and were compared with 19 subjects without a family history of hypertension who were matched for systolic BP and gender. There were no detectable differences in 2-hour average BP, left ventricular (LV) mass or wall thickness, or echocardiographic systolic functional indexes between subjects with and without a family history of hypertension. Doppler-derived diastolic functional indexes demonstrated more prominent late diastolic filling in subjects with a family history of hypertension. Late diastolic transmitral flow time and flow velocity integral were greater (132 ± 24 vs 117 ± 17 ms, p < 0.05; and 2.5 ± 0.7 vs 1.9 ± 0.5 cm, p < 0.01, respectively). To measure possible gender-related effects of a family history of hypertension, the men and women were analyzed separately. The 12 men with a family history of hypertension had greater peak late (40 ± 0.9 vs 31 ± 0.8 cm/s, p < 0.02) and ratio of late-to-early (0.64 ± 0.19 vs 0.46 ± 0.10, p < 0.01) transmitral flow velocities and greater late transmitral flow velocity integrals (2.6 ± 0.8 vs 1.9 ± 0.5 cm, p < 0.05) than the matched male control subjects. In contrast to the men, the female groups differed only in a longer late diastolic flow time in subjects with a family history of hypertension (129 ± 11 vs 109 ± 20 ms, p < 0.05). The minimal findings in the women with a family history of hypertension may be a reflection of the later age of onset of hypertension and its related cardiovascular changes. Thus, in young normotensive men with a family history of hypertension, LV diastolic filling, while still normal, shifted toward the pattern of LV filling observed in hypertensive patients. These findings may represent very early, possibly inherited, characteristics of the hypertension syndrome.