Enhanced radial late systolic pressure augmentation in hypertensive patients with left ventricular hypertrophy.
BACKGROUND
Wave reflection augments central blood pressure (BP) in late systole, thus increasing cardiac afterload. We examined the relationship between late systolic pressure augmentation in the peripheral radial artery pulse wave and the existence of left ventricular hypertrophy (LVH) in hypertension.


METHODS
Brachial BP, radial augmentation index (AI(r)), and carotid-femoral pulse wave velocity (PWV(cf)) were determined in 77 untreated hypertensive patients aged 56 +/- 10 years. Cardiac structure and function were assessed by ultrasound, and LVH was defined based on the LV mass index (LVMI). Using multivariate analysis, patient characteristics were compared between those with (+) and without (-) LVH.


RESULTS
The LVMI was correlated independently and positively with AI(r) (beta = 0.33, P = .004) and the brachial mean arterial pressure (MAP; beta = 0.25, P = .03). The ratio of early to atrial peak velocities (E/A ratio) of the diastolic transmitral flow tended to be correlated negatively with the AI(r). The LVH (+) group had a significantly higher AI(r) than the LVH (-) group [LVH (+), 97% v LVH (-), 89%, P = .003]; this difference remained significant even after adjustment for age, gender, MAP, and heart rate. The adjusted relative risk of LVH was 1.99 for each 10% AI(r) increase (P = .005). In contrast, LVMI was not correlated with the PWV(cf), and the PWV(cf) was not different between the LVH (+) and LVH (-) groups. Moreover, there was no significant correlation between PWV(cf) and AI(r).


CONCLUSIONS
These results suggest that the peripheral AI(r) measurement is clinically useful in predicting LVH. Enhanced wave reflection may be related to the development of LVH in hypertensive patients.
Hashimoto
Junichiro
J
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science and Medicine, 6-3 Aoba, Aramaki, Aoba-ku, Sendai 980-8578, Japan. hashij@mail.tains.tohoku.ac.jp
Watabe
Daisuke
D
Hatanaka
Rieko
R
Hanasawa
Tomohiro
T
Metoki
Hirohito
H
Asayama
Kei
K
Ohkubo
Takayoshi
T
Totsune
Kazuhito
K
Imai
Yutaka
Y
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011673:Pulsatile Flow; D017534:Radial Artery / Q000503:physiopathology*; D012306:Risk