title: Is isolated systolic hypertension in the elderly more associated with left ventricular hypertrophy and significant carotid artery stenosis than mixed hypertension and isolated diastolic hypertension?
abstract: The association of electrocardiographic left ventricular hypertrophy (ECG-LVH) (212 subjects) and haemodynamically significant internal carotid artery stenosis (ICAS) (27 subjects) with isolated systolic hypertension (ISH), mixed hypertension (MHT) and isolated diastolic hypertension (IDH) was studied in untreated elderly patients. Subjects were those aged 67-86 years, drawn from a community screening programme for hypertension in Wales. The prevalence of ECG-LVH with or without repolarisation abnormalities was higher in subjects with ISH (16.6%) than in subjects with mixed hypertension (11.6%, NS). Partial correlation of SBP, DBP, voltage of lead I and SV1+RV5 for each hypertensive subtype showed a consistent positive correlation of DBP with the voltage of lead I and SV1+RV5 in all the subtypes except with the voltage of lead I in IDH subjects. In MHT, the SBP was inversely related to both the voltage of R-wave in lead I and SV1+RV5 (P < 0.03). In IDH, the SBP was positively correlated with the voltage of R-wave in lead I and inversely with SV1+RV5. Atheromatous plaque was present in 40 of 54 (74.1%) internal carotid arteries investigated. The homogeneous type of plaque was predominant in ISH (67%). Heterogenous type of plaque was predominant in the MHT group (50%) and IDH group (43%). The normotensive group did not show any predilection to any morphological type. Plaque was invariably present in the case of ISH, chi 2 = 12.29, 0.1 > P > 0.05. There was more smooth plaque surface in normotensives (79%) and more rough or pitted plaque surface in hypertensives (all types), chi 2 = 6.51, 0.1 > P > 0.05. All normotensives and IDH subjects had non-haemodynamically significant stenosis. Haemodynamically significant stenosis was found in cases of ISH (25%) and MHT (7%); chi 2 = 7.66, 0.1 > P > 0.05. ECG-LVH and haemodynamically significant internal carotid artery stenosis were more commonly found in subjects with ISH than in subjects with MHT. Further studies with larger numbers of patient in each hypertensive subtype would be desirable to confirm these observations.
authors.affiliation: Department of Geriatric Medicine, Brook General Hospital, London, UK.
authors.forename: E B
authors.initials: EB
authors.lastname: Ekpo
authors.forename: A D
authors.initials: AD
authors.lastname: White
authors.forename: M U
authors.initials: MU
authors.lastname: Fernando
authors.forename: I U
authors.initials: IU
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D018608:Ultrasonography, Doppler