PP.15.21] CHANGES IN LEFT VENTRICULAR GEOMETRY AND DIASTOLIC FUNCTION IN PATIENTS WITH RESISTANT HYPERTENSION

Abstract

Objective to evaluate differences of left ventricular (LV) geometry and diastolic function among resistant (rHTN) and controlled (HTN) hypertension patients. Design and method We studied 22 patients with true rHTN confirmed by office and ambulatory blood pressure monitoring (ABPM) despite the use of 3 antihypertensive medications with a diuretic. Ambulatory blood pressure monitoring identified 21 participants with controlled hypertension by triple therapy. Two groups of patients were comparable for age, sex and body mass index. All patients underwent examination including: biochemical evaluations, a complete echocardiographic study, office and ABPM and measurement of circulating concentration of aldosterone, renin, aldosterone-to-renin ratio and 24-hr urinary metanephrines. Results The patients with rHTN had significantly higher LV mass index (LVMI) compared with HTN patients (165.6 ± 8.0 vs. 135.2 ± 5.2 g/m2, p < 0.01). Among HTN patients the prevalence concentric and eccentric left ventricular hypertrophy (LVH) was 61.5% and 28.5%, respectively, and 43% of HTN patients had the moderate increase LVMI and in 47% of HTN patients were detected severe increase LVMI. Concentric LVH was found in all patients with rHTN while LVH was classified as the severe degree. Impairment of LV diastolic function has occurred in two groups but parameters E/e’ (10.1 ± 0.5 vs.7.0 ± 0.6, p < 0.01), isovolumic relaxation time (IVRT) (105.0 ± 4.8 vs. 84.3 ± 7.5 ms, p < 0.05) and deceleration time (DT) (191.5 ± 7.3 vs. 176.7 ± 6.3 ms, p < 0.05) were higher in patients with rHTN compared to HTN patients. Patients with rHTN had significantly higher plasma aldosterone (27.4 ± 2.4 vs. 11.4 ± 1.7 ng/dl, p < 0.01) and 24-hr urinary metanephrines (151.5 ± 8.1 vs. 107.8 ± 11.5, p < 0.01) than HTN patients. There were significant correlations between LVMI with systolic BP during the whole 24-hr period (r = 0.548, p < 0.001), IVRT with LVMI (r = 0.642, p < 0.001), relation wall thickness (r = 0.439, p < 0.01), early filling velocity/late filling velocity (E/A) with plasma aldosterone (r = 0.554, p < 0.01), DT with 24-hr urinary metanephrines (r = 0.713, p < 0.001) in all patients. Conclusions These results suggest that development concentric LV hypertrophy of severe degree with significant LV diastolic abnormalities is associated with uncontrolled 24 h systolic BP, aldosterone excess and increased sympathetic nervous activity in patients with resistant hypertension.