title: Prognostic significance of left ventricular diastolic dysfunction in essential hypertension.
abstract: OBJECTIVE
  We sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension.
  
  
  BACKGROUND
  Alterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated.
  
  
  METHODS
  In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.4 years), 1,839 Caucasian hypertensive patients (50 +/- 12 years, 53% men, blood pressure (BP) 156/98 mm Hg) without previous cardiovascular events, who underwent Doppler echocardiography and 24-h BP monitoring before therapy. The early/atrial (E/A) mitral flow velocity ratio was calculated and corrected for age and heart rate (HR).
  
  
  RESULTS
  During follow-up, there were 164 major cardiovascular events (2.04 per 100 patient-years). The incidence of cardiovascular events was 2.47 and 1.65 per 100 patient-years in patients with an age- and HR-adjusted E/A ratio below (n = 919) and above (n = 920) the median value, respectively (p < 0.005 by the log-rank test). In Cox analysis, controlling for age, gender, diabetes, cholesterol, smoking, LV mass and 24-h systolic BP (all p < 0.05), a low age- and HR-adjusted E/A ratio conferred an increased risk of cardiovascular events (odds ratio 1.57, 95% confidence interval [CI] 1.11 to 2.18, p < 0.01). A 21% excess risk was found for each 0.3 decrease of the adjusted E/A ratio (95% CI from +2% to +43%; p = 0.03).
  
  
  CONCLUSIONS
  Impaired LV early diastolic relaxation, detected by pulsed Doppler echocardiography, identifies hypertensive patients at increased cardiovascular risk. Such association is independent of LV mass and ambulatory BP.
authors.affiliation: Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. skill@unipg.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Leonella
authors.initials: L
authors.lastname: Pasqualini
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vaudo
authors.forename: Simona
authors.initials: S
authors.lastname: Marchesi
authors.forename: Carlo
authors.initials: C
authors.lastname: Porcellati
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003971:Diastole; D015150:Echocardiography, Doppler; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018754:Ventricular Dysfunction / Q000503:physiopathology*