Baroreflex sensitivity correlates with left ventricular morphology and diastolic function in essential hypertension.
OBJECTIVE
Arterial hypertension is a common cause of cardiac organ damage, inducing morphological and functional modifications. Spontaneous baroreflex sensitivity (BRS) control of the heart rate is a key mechanism of blood pressure homeostasis, and is impaired in patients with hypertension. This study sought to assess the association between BRS and left ventricular morphology and function.


METHODS
We studied 224 hypertensive patients (125 men; aged 47.8 +/- 10.8 years, mean +/- SD) compared with 51 normotensive control subjects (25 men, aged 45.7 +/- 12.5 years). Left ventricular morphology, systolic and diastolic function were evaluated by echocardiography. Spontaneous BRS was measured using the sequence method.


RESULTS
BRS was inversely associated with relative wall thickness (R = 0.17; P < 0.0001) and left ventricular mass index (R = 0.03; P = 0.01); in particular, BRS was significantly impaired in patients with concentric left ventricular remodelling (median [interquartile difference] 9.4 [4.1]) and hypertrophy (9.05 [3.9]) compared with the normal left ventricle (12.3 [5]; P < 0.001). BRS showed a significant association with systolic function evaluated by midwall fractional shortening (r = 0.28; P < 0.001), stroke volume (r = 0.27; P < 0.001), stroke work (r = 0.17; P < 0.05), and fractional shortening (r = 0.17; P < 0.05). BRS was significantly decreased in patients with diastolic dysfunction; it was lower in patients with diastolic dysfunction compared with both the control group and hypertensive patients with normal diastolic function.


CONCLUSIONS
BRS is associated with left ventricular morphology, systolic and diastolic function in hypertensive patients. In particular BRS is impaired in patients with diastolic dysfunction. These findings suggest a role for BRS as a target in arterial hypertension.
Milan
Alberto
A
Department of Medicine and Experimental Oncology, Hypertension Unit, University of Torino, Turin, Italy. alby.milan@libero.it
Caserta
Mimma A
MA
Del Colle
Sara
S
Dematteis
Antonio
A
Morello
Fulvio
F
Rabbia
Franco
F
Mulatero
Paolo
P
Pandian
Natesa G
NG
Veglio
Franco
F
D000328:Adult; D017704:Baroreflex / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged