Effect of regression of left ventricular hypertrophy from systemic hypertension on systolic function assessed by midwall shortening (HOT echocardiographic study).

Depressed midwall shortening has been shown to be an independent predictor of cardiovascular morbid events in hypertensive patients with left ventricular (LV) hypertrophy despite normal endocardial fractional shortening. The effects of LV mass changes in hypertensive patients on midwall shortening are unclear. To determine the impact of LV hypertrophy regression on LV systolic function assessed at the endocardium and the midwall level, 508 patients (58% men, 57% Caucasians, mean age 60 +/- 7 years) participating in the Hypertension Optimal Treatment study were prospectively studied by serial echocardiography at baseline, year 1, year 2, and at the end of the study. The Hypertension Optimal Treatment study was designed to challenge the existence of the J-curve phenomenon in hypertension. This study enrolled men and women between 50 and 80 years of age with mild to moderate hypertension. Patients were treated with a regimen based on felodipine with the addition of other antihypertensive drug classes as needed to reduce the diastolic blood pressure to a predefined target of < or =80, < or =85, or < or =90 mm Hg. From baseline to year 1, year 2, and end of the study, body mass index was unchanged (30.4, 30.1, 30.2, and 30.5 kg/m(2)); however, diastolic blood pressure was significantly reduced (99, 83, 80, and 80 mm Hg, p <0.0001), as was systolic blood pressure (161, 139, 137, and 134 mm Hg, p <0.0001) and LV mass index (117, 119, 107, and 106 g/m(2), p <0.0001). Over the same period of observation the endocardial fractional shortening did not change significantly (40%, 42%, 43%, and 44%); however, shortening at the midwall level showed improvement (20%, 21%, 22%, and 30%, p <0.001). In conclusion, midwall shortening is a more sensitive index of systolic function in subjects with pressure-overload hypertrophy, and it identifies high-risk patients who may benefit from a more aggressive antihypertensive program. The disparity between midwall and endocardial shortening suggests reduced myofibril function in patients with hypertension-induced hypertrophy.

Comparison in systemic hypertension of left ventricular mass and geometry with systolic and diastolic function in patients <65 to > or = 65 years of age.

Previous studies have differed on the independent effect of age and gender to left ventricular (LV) mass. Data on ventricular remodeling in hypertensive patients > or = 65 years of age is lacking. Similarly, the systolic and diastolic interaction in older hypertensives is not well defined. In a prospective study, we examined the relation of LV mass, relative wall thickness, and systolic and diastolic interaction in 508 hypertensive patients between 50 and 80 years of age who were divided according to age (<65 and > or = 65 years) and gender. LV mass, geometric classification, systolic wall stress, and Doppler filling were obtained according to standard Doppler echocardiographic criteria. In men, most measurements were similarly distributed. However, women > or = 65 years of age had smaller LV systolic dimensions, thicker ventricular septums, higher endocardial and midwall fractional shortenings, and lower end-systolic wall stress. Although LV mass was higher in men, there was no age difference within the same sex. The most common LV geometric remodeling was increased relative wall thickness in the form of concentric hypertrophy or concentric remodeled. The predominant mitral flow pattern was "impaired relaxation"; however, older patients had even shorter E waves, taller A waves, and lower E/A ratios. Thus, patients > or = 65 years of age had an even higher prevalence of this pattern (men, 89% vs 73%, p <0.001, and women, 91% vs 77%, p <0.001). Delayed LV relaxation with preservation of systolic ejection indexes is an early abnormality in essential hypertension, which lasts an undetermined time with further progression as patients aged. As a result, hypertensive patients > or = 65 years of age had the most pronounced structural and functional changes, an observation particularly noted in women. In those > or = 65 years, data from the Doppler E wave and A wave do not distinguish the physiologic process of aging from the pathologic changes of pressure overload.