Implications of persistent prehypertension for ageing-related changes in left ventricular geometry and function: the MONICA/KORA Augsburg study.
BACKGROUND
It is unclear whether persistent prehypertension causes structural or functional alterations of the heart.


METHODS
We examined echocardiographic data of 1005 adults from a population-based survey at baseline in 1994/1995 and at follow-up in 2004/2005. We compared individuals who had either persistently normal (<120 mmHg systolic and <80 mmHg diastolic, n = 142) or prehypertensive blood pressure (120-139 mmHg or 80-89 mmHg, n = 119) at both examinations using multivariate regression modeling.


RESULTS
Over 10 years, left ventricular end-diastolic diameters were stable and did not differ between the two groups. However, the prehypertensive blood pressure group displayed more pronounced ageing-related increases of left ventricular wall thickness (+4.7 versus +11.9%, P < 0.001) and left ventricular mass (+8.6 versus +15.7%, P = 0.006). Prehypertension was associated with a raised incidence of left ventricular concentric remodeling (adjusted odds ratio 10.7, 95% confidence interval 2.82-40.4) and left ventricular hypertrophy (adjusted odds ratio 5.33, 1.58-17.9). The ratio of early and late diastolic peak transmitral flow velocities (E/A) decreased by 7.7% in the normal blood pressure versus 15.7% in the prehypertensive blood pressure group (P = 0.003) and at follow-up the ratio of early diastolic peak transmitral flow and early diastolic peak myocardial relaxation velocities (E/EM) was higher (9.1 versus 8.5, P = 0.031) and left atrial size was larger (36.5 versus 35.3 mm, P = 0.024) in the prehypertensive blood pressure group. Finally, the adjusted odds ratio for incident diastolic dysfunction was 2.52 (1.01-6.31) for the prehypertensive blood pressure group.


CONCLUSIONS
Persistent prehypertension accelerates the development of hypertrophy and diastolic dysfunction of the heart.
Markus
Marcello Ricardo Paulista
MR
Medical Clinic II, University of Lübeck Medical School, Lübeck, Germany.
Stritzke
Jan
J
Lieb
Wolfgang
W
Mayer
Björn
B
Luchner
Andreas
A
Döring
Angela
A
Keil
Ulrich
U
Hense
Hans-Werner
HW
Schunkert
Heribert
H
D000328:Adult; D000375:Aging; D003971:Diastole / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D016017:Odds Ratio