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Unraveling the Structural and Functional Adaptations in Hypertensive Heart Disease: What Lies Beyond Left Ventricular Hypertrophy?
Session:
Sessão de Posters 07 - Hipertensão arterial
Speaker:
António Baptista Carvalho
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
António Baptista Carvalho; José Ferreira Santos; Duarte Espregueira Mendes; Rita Gomes; Rita Rodrigues; Rita Santos; Vânia Madeira; Patrícia Amado; Catarina Sousa; Sónia Balão; João Colaço; Lígia Mendes
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Historically, hypertensive heart disease (HHD) has been associated with left ventricular hypertrophy (LVH). Nevertheless, a universally accepted definition of HHD is lacking, which should encompass a broader spectrum of hypertension-induced organ damage, including both structural and functional adaptations, extending beyond LVH.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">To assess and delineate, using transthoracic echocardiography, the structural and functional findings characteristic of HHD in patients diagnosed with hypertension.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We conducted a retrospective assessment of consecutive patients referred for hypertension evaluation and undergoing ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography within a six-month timeframe, over a one-year period at a single center. Both echocardiographic assessments and ABPM followed established best practices. Patients were categorized into three groups: controls (without hypertension), with controlled hypertension and with uncontrolled hypertension. Morphological and functional echocardiographic findings were compared across these groups to identify variations that define HHD. </span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Our analysis included 1951 patients (median age 60 ± 13 years, with 51% male). 385 patients (20%) exhibited normal blood pressure readings during ABPM (mean blood pressure 115 ± 8 / 71 ± 6 mmHg) and were considered the control group. 904 (48%) patients had controlled hypertension (mean blood pressure 115 ± 9 / 68 ± 7 mmHg), and 599 (32%) had uncontrolled hypertension (mean blood pressure 135 ± 10 / 81 ± 7 mmHg). 39% patients received no blood pressure treatment, 24% were treated with a single drug, 27% with two drugs, and 10% with three or more drugs. Structural and functional echocardiographic parameters are presented in Table 1. In comparison to the control group, patients with controlled and uncontrolled hypertension exhibited enlarged ascending aorta and atria, reduced early filling tissue Doppler velocities and E/e’ ratios, elevated A wave velocities, and higher left ventricular (LV) mass, consistent with classical HHD.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">HHD encompasses a multitude of structural and functional echocardiographic features extending beyond simple LVH. This broader spectrum of findings should be taken into account when assessing patients with hypertension.</span></span></p>
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