[Variants of heart remodeling in essential hypertension: prevalence and determinants].

AIM: To study myocardial remodeling (MR) in hypertensive patients with normal and excessive body mass, to analyse MR features depending on clinical and hemodynamic parameters. MATERIAL AND METHODS: Structural-functional conditions of the myocardium were studied with echocardiography, and determination of left ventricular remodeling (LVR) type was made in 734 untreated hypertensive patients aged 19-76 years. RESULTS: Patients with essential hypertension (EH) stage I had mostly excentric left ventricular hypertrophy (LVH). The number of patients with concentric LVH increases with age, disease severity. This type of LVH occurs more frequently in males than in females. In females, LVH severity depends, primarily, on the degree of obesity. If EH combines with obesity, structural alterations of the myocardium are more prominent than in isolated pathology. In android obesity, LVH is more frequent. CONCLUSION: In EH, structural alterations of the heart and a LVR variant are determined, besides arterial pressure, by such factors as age and gender, duration of EH, obesity, its degree and kind.

Prevalence and determinants of left ventricular hypertrophy and remodelling patterns in hypertensive patients: the St. Petersburg study.

OBJECTIVE: The primary aim of the present study was to determine the prevalence of left ventricular hypertrophy (LVH) in hypertensive patients with the use of different threshold values and also to assess the distribution of left ventricular (LV) geometry patterns verified by two different methods of relative wall thickness (RWT) calculation. The secondary aim was to evaluate the impact of different demographic determinants into prevalence of LVH and remodelling patterns. PATIENTS AND METHODS: A cross-sectional study in a population-based sample of 734 essential hypertensives from the primary care clinic was undertaken. Echocardiography was performed and analysed by trained observers. The LV posterior wall thickness (PWd), interventricular septum (IVSd) and LV mass index (LVMI) were measured. The following criteria for LVH definition were used: LVMI >125 g/m2 and 134/110 g/m2, and >131/110 and 116/104 g/m2 in males/females, respectively. The RWT was calculated as a 2PWd/LVDD or PWd + IVSd/LVDD, where LVDD is the LV internal dimension at the end of diastole. The values exceeding 0.45 were considered evidence for concentric remodelling. RESULTS: Prevalence of LVH ranged from 52.2 to 72.2% by the use of different threshold for LVH definition. It was shown that the LVH estimation without sex-specific criteria underestimates the prevalence of LVH in women and overestimates it in men. The prevalence of concentric LVH and concentric remodelling was higher when the IVSd was included in the RWT calculation. Only one-quarter of patients were free from morphological alterations and eccentric LVH was as frequently observed as concentric LVH. Sex, obesity stage and type as well as hypertension level and duration contributed to LVH level and remodelling pattern. CONCLUSIONS: The use of different threshold values can significantly influence the assessment of prevalence of LVH in hypertension. The "mild" criteria, to our opinion, can overestimate the prevalence of structural LV remodelling, while implementation of sex-specific criteria for the definition of LVH increases the sensitivity of the method. In any way, eccentric LVH is as common for hypertension as a concentric LVH, the proportion of the latter increasing with age and more frequently observed in males. Concomitant obesity, in particular abdominal, significantly increases LVH prevalence.

[Association of a polymorphic marker C825T of the beta(3) subunit of G-protein with myocardial hypertrophy in patients with hypertensive disease]. / Izuchenie assotsiatsii polimorfnogo markera C825T gena beta 3-sub"edinitsy G-belka s gipertrofiei miokarda levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To elucidate association of a polymorphic marker C825T of the beta(3)-subunit of G-protein with myocardial hypertrophy in hypertension. MATERIAL AND METHODS: Alleles of polymorphic marker C825T of the CNB3 gene were identified by polymerase chain reaction with subsequent cleavage of the product by BseDI restrictase in 135 patients with hypertensive disease (essential hypertension). Left ventricular mass was determined by echocardiography. RESULTS: Patients with and without left ventricular hypertrophy had similar frequencies of T allele of the gene studied. Moreover patients with CC, CT and TT genotypes had similar left ventricular mass index (122.3+/-29.8, 118.8+/-29.9, and 115.2+/-18.3 g/m(2), respectively). CONCLUSION: No association exists between polymorphic marker C825T of the CNB3 gene and left ventricular hypertrophy in patients with essential hypertension.

[Spectral analysis of the heart rate variability in various types of the left heart ventricle remodelling in patients with hypertension]. / Spektral'nyi analiz variabel'nosti serdechnogo ritma pri razlichnykh variantakh remodelirovaniia levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu.

Autonomic cardiac regulation in different types (normal, concentric, and eccentric geometries) of the left ventricle (LV) was evaluated in 86 hypertensive patients. LV structure and function were evaluated by echocardiography). To calculate heart rate variability (HRV), 512 RR intervals were measured in supine rest and passive tilt. Power spectral analysis with fast Furrier transform was used to derive low- and high-frequency power spectra and the sympathovagal index (SVI). In the normal LV geometry group, there was a good response to the tilt test, by causing a 3-fold increase in SVI while in the two LV hypertrophy groups, the index was virtually unchanged or even decreased. The normal LV geometry group patients showed a positive correlation between low-frequency power and the relative LV wall thickness (RLVWT) while the two LV hypertrophy groups did increases in RLVWT and LV myocardial mass, which were associated with a reduction in HRV. In conclusion, HRV is significantly reduced in essential hypertension and is also closely connected with cardiac structure and function. Patients with normal LV geometry showed a preserved response to the tilt test. LVH produces significant autonomic regulatory disturbances possibly due to the lower sensitivity of cardiac adrenoceptors independently of the pattern of LV hypertrophy.

Power spectral components of heart rate variability in different types of cardiac remodelling in hypertensive patients.

BACKGROUND: The aim of the study was to evaluate whether there are any significant differences in cardiac autonomic regulation in distinct types of hypertensive cardiac remodelling. MATERIAL AND METHODS: We examined 86 patients with mild to moderate essential hypertension (EH). The parameters of left ventricle (LV) were measured by echocardiography: the diastolic mass normalized for body surface area (LVMI) and relative wall thickness (RWT). All patients were divided into three groups: normal LV geometry (23), concentric left ventricular hypertrophy (LVH) (29) and eccentric LVH (34). The control group included 30 age and sex-matched healthy volunteers. For calculation of heart rate variability (HRV) 512 RR intervals in supine rest and passive tilt were measured. Power spectral analysis with fast Furrier transform was used to obtain the total power, low frequency (LF) power (from 0.003 to 0.14 Hz), high frequency (HF) power (from 0.15 to 0.40 Hz) and sympathovagal index (SVI) as LF:HF ratio. RESULTS: The parameters of HRV did not differ significantly among the groups studied. In the group with normal LV geometry there was observed a good response to tilt test resulting in an increase of SVI in three times (from 2.4 +/- 0.3 to 7.2 +/- 0.4), while in patients with both types of LVH there were no significant changes in SVI or even an inverse reaction to passive tilt. In the group with normal geometry patients with higher meanings of RWT had higher LF power (r = 0.52, p < 0.01), while in patients with LVH the increasement of LVMI and RWT was associated with reduction of HRV (rr = -0.43, -0.36, p < 0.05, respectively). CONCLUSIONS: Heart rate variability is significantly reduced in essential hypertension and is also closely connected with cardiac structure and function. Patients with normal LV geometry are characterized by a preserved response to tilt test. LVH produce significant disturbances of autonomic regulation possibly due to lower sensitivity of cardiac adrenoreceptors independently of the LVH pattern.

Correction of hypertensive cardiac remodelling: comparison of different antihypertensive therapies.

The aim of the study was to compare the effects of long-term treatment with different types of antihypertensive drugs on left ventricular hypertrophy (LVH) and diastolic function in patients with essential hypertension. We examined 60 patients with mild to moderate hypertension from 35 to 55 years old (middle age 44.3 +/- 2.3 yrs) having no concomitant diseases. Patients were treated for six months with different types of antihypertensive drugs: 21 patient received nifedipine-retard 40 mg/day, 20--atenolol 100 mg/day, 10--losartan potassium 100 mg/day, 9--perindopril 4 mg/day. Cardiac structure and function was studied by echocardiography. For the left ventricle (LV) the diastolic mass normalised for body surface area (LVMI), the ratio of the early and atrial mitral inflow velocities (E/A), isovolumetric relaxation time (IVRT), relative wall thickness (RWT) were measured. After six months of treatment LVMI decreased by 9% in nifedipine group (P < 0.01), by 10.5% in atenolol group (P < 0.01), by 12% in losartan group (P < 0.01) and by 8.2% in perindopril group (NS). RWT decreased in all groups, while diastolic dimension index remained unchanged. The reversal of LVH was not related to blood pressure reduction. It was more significant in patients with initially higher values of LVMI. Antihypertensive effects of the drugs were comparable. Long-term treatment with all types of selected drugs improves cardiac structure and function independently of their antihypertensive action. Our data suggest that on the basis of the influence on cardiac remodelling no preference for any studied drug can be discerned. The work had the following source of support: the atenolol (Falitonsin) and nifedipine-retard (Corinfar-retard) were provided by the AWD Company (Germany), losartan potassium has been provided by Merck Sharp & Dohme Company and perindopril (Prestarium) by the Servier Group.