title: Relative impact of blood pressure as compared to an excess adiposity on left ventricular diastolic dysfunction in a community sample with a high prevalence of obesity.
abstract: OBJECTIVE
  To determine whether blood pressure (BP) or an excess adiposity, both frequently observed comorbidities that independently relate to left ventricular diastolic dysfunction (LVDD), have a greater impact on LVDD at a community level.
  
  
  METHODS
  We assessed the relative independent impact of an excess adiposity versus BP on indices of LVDD as determined from the ratios of early-to-late transmitral blood flow velocity (E/A) and E/the mean of lateral and septal wall myocardial tissue lengthening at the level of the mitral annulus (e'; (E/e') in 417 randomly recruited participants of a community-based study with a high prevalence of excess adiposity (43% obese and 25% morbidly obese).
  
  
  RESULTS
  In multivariate adjusted models, including adjustments for appropriate BP values (SBP for E/e' and DBP for E/A), waist circumference was independently associated with E/A (partial r = -0.12, P < 0.02) and E/e' (partial r = 0.15, P < 0.005). In contrast, BMI was independently associated with E/e' (partial r = 0.11, P < 0.05), but not E/A (partial r = -0.09, P = 0.08). In multivariate models, SBP had a greater impact on E/e' (standardized β-coefficient = 0.32 ± 0.05, P < 0.0001) than did waist circumference (standardized β-coefficient = 0.16 ± 0.05, P < 0.005; P < 0.05 for comparison), whereas DBP had a similar impact on E/A (standardized β-coefficient = -0.10 ± 0.03, P < 0.005) as did waist circumference (standardized β-coefficient = -0.10 ± 0.04, P < 0.05). Importantly, whereas SBP was the main factor independently associated with an increased E/e' (≥10) (P < 0.0005), waist circumference was not independently associated with either a decreased E/A (≤0.75) (P = 0.82) or an increased E/e' (≥10; P = 0.15).
  
  
  CONCLUSIONS
  In a community sample with a high prevalence of excess adiposity, BP exceeds obesity as the most important modifiable risk factor for LVDD. These data suggest that in communities with a high prevalence of obesity, if weight loss programmes fail to produce sustainable target body weights, rigorous BP management to lower than normal thresholds may be sufficient to prevent LVDD.
authors.affiliation: aCardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology bDepartment of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa *Aletta M.E. Millen, Carlos D. Libhaber, Angela J. Woodiwiss, and Gavin R. Norton contributed equally to the writing of this article.
authors.forename: Aletta M E
authors.initials: AM
authors.lastname: Millen
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Libhaber
authors.forename: Olebogeng H I
authors.initials: OH
authors.lastname: Majane
authors.forename: Elena
authors.initials: E
authors.lastname: Libhaber
authors.forename: Muzi J
authors.initials: MJ
authors.lastname: Maseko
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Woodiwiss
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Norton
mesh_terms: D050154:Adiposity; D001783:Blood Flow Velocity; D001794:Blood Pressure; D003153:Community Health Services; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid; D013019:South Africa; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055105:Waist Circumference