Comparison of left ventricular mass and geometric remodeling in treated and untreated men and women >50 years of age with systemic hypertension

Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension

OBJECTIVE

The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood.

METHODS

Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry.

RESULTS

Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m), but it was lower in the normotensive group (41.7 ± 0.9 g/m; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyns/cm), whereas controlled HTN group (1925 ± 527 dyns/cm) was not different to either groups.

CONCLUSION

Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.

Left ventricular structure and geometry, peripheral artery endotheliumdependent vasodilatation, antihypertensive effect of ACE inhibitors, and hormone replacement therapy in premenopausal women with arterial hypertension

Aim.To summarize the data on the 7-month treatment with ACE inhibitors (lisinopril) and hormone replacement therapy, HRT (femoston) – in particular, the effects on left ventricular (LV) structure and geometry, peripheral artery endothelium-dependent vasodilatation (EDVD), blood pressure (BP), and clinical perimenopausal symptoms – in premenopausal women with arterial hypertension (AH).Material and methods.The study included 84 premenopausal women with Stage II AH and LV myocardial hypertrophy (LVH). Group I (47 women; mean age 48,6 years). The clinical symptoms included nighttime hyperhidrosis and hot flashes. In Group II (37 women, mean age 53,2 years). The clinical symptoms in Group II participants included hyperhidrosis, hot flashes, malaise, and dysphoria. Group II received lisinopril (1– mg/day) and femoston (2/10/2 mg); Group I was administered lisinopril in the same dose and placebo. Clinical examination, the measurement of BP and heart rate (HR), ECG, EDVD assessment, and echocardiography (EchoCG) were performed at baseline, during the treatment, and 7 months after the end of the treatment.Results.Lisinopril therapy demonstrated a good antihypertensive effect in premenopausal women with AH, while also preventing the progression of LVH and dilatation of left heart chambers.Conclusion.The studied medications improved peripheral artery endothelial function and were well tolerated. Femoston was highly compatible with cardiac therapy and effectively reduced clinical symptoms in premenopausal women with AH.

An analysis of cardiac remodeling in the elderly population. EPICARDIAN study

The aims of this study were to investigate left ventricular morphology in a sample of elderly Spanish individuals and to assess differences between hypertensives and normotensives. Data were obtained from a subsample (N=242) of participants in the EPICARDIAN study who live to the Lista district of Madrid: they included 191 (78.8%) hypertensives and 51 (21.2%) normotensives. Left ventricular remodeling patterns were classified as: type I (normal), type II (concentric remodeling), type III (concentric hypertrophy) or type IV (eccentric hypertrophy). The overall prevalences were: 74 (30.5%) type I, 62 (25.9%) type II, 53 (21.8%) type III and 53 (21.8%) type IV. A comparison of hypertensives and normotensives showed that the prevalences were: 42 (22.3%) type I, 50 (26.1%) type II, 50 (26.1%) type III and 49 (25.5%) type IV in hypertensives and 31 (60%) type I, 13 (26%) type II, 3 (6%) type III and 4 (8%) type IV in normotensives (P< .0005). Ventricular remodeling without hypertrophy was common in the elderly, an observation that could have prognostic implications.

Large-artery stiffness contributes to the greater prevalence of systolic hypertension in elderly women

OBJECTIVES

To determine whether sex differences in large-artery stiffness contribute to the greater prevalence of systolic hypertension in elderly women than in elderly men.

DESIGN

During a single visit arterial stiffness was assessed in the unmedicated state using four parameters.

PARTICIPANTS

Three hundred seventy-four women with a mean age+/-standard deviation of 72+/-5 and 296 men aged 71+/-5 participated.

SETTING

Hypertensive patients were recruited from general practice as part of the second Australian National Blood Pressure Study in Melbourne, Australia.

MEASUREMENTS

Large-artery stiffness was assessed using multiple methodologies, including aortic arch stiffness (beta-index) using M-mode ultrasound and arterial compliance and augmentation index using noninvasive carotid pressure and aortic flow measurements.

RESULTS

Women had greater carotid and brachial pulse pressure (PP) than men (P<.001), despite higher mean arterial pressure in men. Mean arterial compliance was lower in women (0.20+/-0.12 vs 0.28+/-0.16 mL/mmHg, P<.001) even after correction for aortic area, and aortic arch stiffness was higher (30+/-36 vs 23+/-22; P<.01). Consistent with both a stiffer proximal circulation and a shorter distance to reflection sites, women had higher augmentation index (38+/-11% vs 29+/-12%, P<.001). In multivariate analysis, sex was an independent determinant of all arterial stiffness indices.

CONCLUSION

Independently of known confounders, elderly hypertensive women have stiffer large arteries, greater central wave reflection, and higher PP than elderly men. Stiffer large arteries likely contribute to the greater prevalence of systolic hypertension in elderly women and may partly explain the acceleration in postmenopausal cerebrovascular and cardiac complications.