The impact of different echocardiographic diagnostic criteria on the prevalence of left ventricular hypertrophy in essential hypertension: the VITAE study. Ventriculo Izquierdo Tension Arterial España.

BACKGROUND: The prevalence of echocardiographic left ventricular hypertrophy in essential hypertension ranges from 12 to 96% depending on the threshold values used to define it, and on the selection bias. OBJECTIVE: To estimate the prevalence of echocardiographic left ventricular hypertrophy by different criteria in essential hypertensives seen in primary care centres. METHODS: Cross-sectional study in a population-based sample of 946 essential hypertensives randomly selected in 39 primary care centres across Spain. Echocardiographic studies were performed in reference hospitals by trained observers (concordance Cohen kappa index > 0.7) and analysed by a single observer. RESULTS: Prevalence of left ventricular hypertrophy ranged from 59.2% [95% confidence interval (CI) 56.1 -62.3] by Framingham criteria to 72.7% (95% CI 69.9-75.6) using the criteria of De Simone et al. (J Am Coll Cardiol 1995; 25: 1056-1062). Prevalence was higher in males by the Cornell-Penn criteria, but higher in females when using Framingham or De Simone et al. criteria. Eccentric hypertrophy was more frequent (51.3-54.1%) independently of the criteria used, particularly when adjusting wall-thickness-ratio for age (56.2-58.9%). Concentric remodelling was present in 6.5-11.4% and only 20.8-29.7% of patients had no evidence of left ventricular structural alterations. Factors independently associated with left ventricular hypertrophy in the logistic regression analysis were age, gender, systolic blood pressure, pulse pressure and body mass index. CONCLUSION: Prevalence of echo left ventricular structural alterations among essential hypertensives seen in primary care centres in Spain ranged from 70.3 to 79.2% depending on the threshold values used. Left ventricular hypertrophy ranged from 59.2 to 72.7% and age-adjusted concentric remodelling ranged from 6.5 to 11.4% depending on the criteria used. Only one-quarter of hypertensive patients were free from morphological alterations.

[Improvement in diastolic function in hypertensive patients with left ventricular hypertrophy with inhibitors of the angiotensin converting enzyme]. / Mejoría de la función diastólica en pacientes hipertensos con hipertrofia ventricular izquierda mediante inhibidores de la enzima de conversión de la angiotensina.

An open and multicentric study was conducted with 66 patients with mild to severe diastolic arterial hypertension and echocardiographic left ventricular hypertrophy, the evolution of diastolic function, by means of doppler transmitral flow echocardiography, under treatment with ramipril, an angiotensin converting enzyme inhibitor, at a dose of 2.5 and 5 mg/day, or combined with a diuretic, after three and six months of treatment. Despite not obtaining the tensional control in all patients, a decrease in the mass, both in absolute values and mass index, was obtained. This decrease was observed both in male and female patients from the first three months, which went on until the sixth month, thus suggesting an independent action of the hemodynamic load decrease for the obtention of this effect. There was also a change in the ventricular geometry with a displacement of patients from concentric enlargement to normal, remodelling and eccentric enlargement. The diastolic function improved both for the early and for the late maximal filling velocity, relationship between both, and deceleration time, although the time during which this improvement occurred was different for each parameter, thus indicating the different influence of the dynamic and structural factors on these parameters. No correlation was found between the improvement in diastolic function and hypertrophy regression. We can conclude that ramipril is useful for the control of the left ventricular hypertrophy and diastolic function, irrespective of arterial tension values.

Treatment of diastolic dysfunction in hypertensive patients without left ventricular hypertrophy.

The aim of this study was to evaluate the influence of verapamil SR 240 mg (V) and the combination amiloride 5 mg + hydrochlorothiazide 50 mg (AH) on diastolic dysfunction of hypertensive patients without left ventricular hypertrophy (LVH). Twenty-six hypertensive patients with diastolic dysfunction, normal systolic function and without LVH were included into a 2-week washout period and then randomised to a 6-month V or AH treatment. One blinded-to-treatment echocardiographist at baseline and at weeks 4, 12 and 24 assessed Doppler-echocardiography. Both V and AH, satisfactorily controlled blood pressure, but only V improved diastolic function shown by a tendency to reduce peak A and to increase peak E/A ratio, and by a significant reduction in deceleration time. After 24 weeks, V significantly reduced wall thickness in comparison with AH. These results need to be confirmed in a larger scale study.

[Hypertensive cardiopathy. Studies on left ventricular hypertrophy]. / Cardiopatía hipertensiva. Estudios sobre hipertrofia ventricular izquierda.

This paper reviews the work of the cardiology Service of the Hospital de Basurto de Bilbao on hypertensive cardiomyopathy, diastolic disfunction and exercise tolerance, presenting a new pathophysiologic classification and the possibility of altering the underlying functional factors. The paper also reviews the presentation and evolution of microvascular angina in hypertensive patients.

Usefulness of exercise testing performed with vasodilators for predicting the severity of myocardial ischaemia during daily activities and treatment.

Fifty patients (aged 53 +/- 7 years) with confirmed coronary disease performed two stress tests (baseline and following treatment with vasodilators) and were divided into two groups: (A) fixed ischaemic threshold (n = 27), and (B) variable ischaemic threshold (n = 23). All patients underwent 24-h baseline Holter monitoring and monitoring following treatment with nifedipine, placebo, propranolol and nifedipine + propranolol. In Group A, 92% of ischaemic episodes occurred at heart rates similar to those found during exercise testing. In Group B, the heart rate was lower in 66%. In Group A, positive stress testing before the first 3 min of exercise, or at < 140 beat,min-1 with ST segment depressions > or = 0.02 mV, correlated with higher Holter indexes. In Group A, propranolol reduced both the number of episodes and total ischaemia time. In Group B, the best effects were achieved with nifedipine and combined treatment. Our results further emphasize the contrasts between patients with angina and fixed and variable ischaemic thresholds and suggest that therapy tailored to the physiopathology may be most efficacious.

Treatment of transient myocardial ischemia in patients with stable angina: a comparative study of verapamil slow-release and nifedipine plus propranolol.

We compared the effect of verapamil slow-release (VSR) and the combination of nifedipine plus propranolol on transient myocardial ischemia in a double-blind study comprising 20 patients with proven coronary artery disease and chronic stable angina. According to the results of 24-h Holter-monitoring recording, patients were divided into two groups: 10 patients with fixed coronary reserve and 10 patients with variable coronary reserve. The number of ischemic events was reduced with both therapies: from 12 +/- 10 at baseline to 3.4 +/- 4.0 (p less than 0.05) with verapamil and to 3.9 +/- 7.0 (p less than 0.05) with nifedipine plus propranolol (N + P). When total ischemic burden was measured, findings were similar: It was reduced from 104 +/- 196 min to 27 +/- 57 (p less than 0.05) with N + P and to 17 +/- 18 min with verapamil in patients with fixed coronary reserve and from 36 +/- 44 to 5 +/- 9 min (p less than 0.05) with verapamil and to 5 +/- 10 min with N + P in patients with a variable coronary reserve. VSR shows antiischemic efficacy similar to that of the combination of N + P in treatment of transient myocardial ischemia in patients with stable angina.