Untreated essential hypertension is associated with diverse geometric adaptation, where eccentric hypertrophy (27%) and concentric remodeling (13%) are more common than typical concentric hypertrophy (8%).
Cross-Sectional (n=290)
What are the patterns of left ventricular geometric adaptation and systemic hemodynamics in patients with untreated essential hypertension compared to normal adults?
In untreated essential hypertension, concentric remodeling and eccentric hypertrophy are more common geometric adaptations than typical concentric hypertrophy, and these patterns correlate with distinct systemic hemodynamics.
The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables). Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was super-normal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p less than 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload. Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.
Ganau et al. (1992) conducted a cross-sectional in Essential hypertension (n=290). Untreated essential hypertension vs. Age- and gender-matched normal adults was evaluated on Left ventricular geometric adaptation (left ventricular mass index and relative wall thickness). Untreated essential hypertension is associated with diverse geometric adaptation, where eccentric hypertrophy (27%) and concentric remodeling (13%) are more common than typical concentric hypertrophy (8%).
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