title: Relation of left ventricular geometry and function to systemic hemodynamics in hypertension: the LIFE Study. Losartan Intervention For Endpoint Reduction in Hypertension Study.
abstract: OBJECTIVE
  To clarify the relations of systemic hemodynamics to left ventricular (LV) geometric patterns in patients with moderate hypertension and target organ damage.
  
  
  BACKGROUND
  LV geometry stratifies risk in hypertension, but relations of LV geometry to systemic hemodynamic patterns in moderately severe hypertension have not been fully elucidated.
  
  
  METHODS
  Cross-sectional case-control study.
  
  
  METHODS
  Baseline findings in the echocardiographic substudy of the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE) and in a normotensive reference group.
  
  
  METHODS
  Nine hundred and sixty-four patients with Stage I-II hypertension and LV hypertrophy by Cornell voltage duration criteria ((SV3 + RaVL [+ 6 mm in women]) x QRS > 2440 mm x ms) or modified Sokolow- Lyon voltage criteria (SV1 + RV5/RV6 > 38 mm), and 366 apparently normal adults.
  
  
  METHODS
  None.
  
  
  METHODS
  Two-dimensional and Doppler echocardiograms were used to classify hypertensive patients into groups with normal geometry, concentric remodelling and concentric and eccentric hypertrophy, and to measure stroke volume (SV), cardiac output, peripheral resistance and pulse pressure/SV as a measure of arterial stiffness. Comparisons were adjusted for covariates by general linear model with the Sidak post-hoc test
  
  
  RESULTS
  Mean SV was higher in patients with eccentric hypertrophy (83 ml/beat) and lower with concentric remodeling (68 ml/beat) than in normal adults (73 ml/ beat). Cardiac output was highest in patients with eccentric LV hypertrophy and lower with concentric remodeling than eccentric hypertrophy; mean pressure and peripheral resistance were equally high in all hypertensive subgroups, whereas pulse pressure/SV was most elevated (by a mean of 47% versus reference subjects) with concentric remodeling and least so (mean + 15%) with eccentric hypertrophy. In multivariate analysis (Multiple R + 0.68), LV mass was independently related to higher systolic pressure, older age, SV, male gender and body mass index (all P< 0.001). Relative wall thickness was independently related (Multiple R + 0.50) to older age, higher systolic pressure, lower SV (all P< 0.001) and higher body mass index (P + 0.007). SV and cardiac output were lower in patients with low stress-corrected midwall shortening.
  
  
  CONCLUSIONS
  In patients with moderate hypertension and ECG LV hypertrophy, the levels of SV and pulse pressure/ SV, are associated with, and may be stimuli to different LV geometric phenotypes.
authors.affiliation: Cornell Medical Center, New York, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Bella
authors.forename: K
authors.initials: K
authors.lastname: Wachtell
authors.forename: V
authors.initials: V
authors.lastname: Palmieri
authors.forename: P R
authors.initials: PR
authors.lastname: Liebson
authors.forename: E
authors.initials: E
authors.lastname: Gerdts
authors.forename: A
authors.initials: A
authors.lastname: Ylitalo
authors.forename: M J
authors.initials: MJ
authors.lastname: Koren
authors.forename: O L
authors.initials: OL
authors.lastname: Pedersen
authors.forename: J
authors.initials: J
authors.lastname: Rokkedal
authors.forename: B
authors.initials: B
authors.lastname: Dahlöf
authors.forename: M J
authors.initials: MJ
authors.lastname: Roman
authors.forename: R B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016277:Ventricular Function, Left