Maria Radice

Left ventricular structure and function in normotensive adolescents with a genetic predisposition to hypertension

It has been suggested that the heart plays an active role in the pathogenesis of arterial hypertension. If this is true, there must be early cardiac involvement in young normotensive subjects who develop hypertension later in life and differences in cardiac morphology or function may exist between young normotensive subjects with different risks of developing hypertension. M-mode echocardiography was performed in 51 normotensive male adolescents with at least one hypertensive parent (SHT). These subjects were compared with 55 normotensive sons of normotensive parents (SNT) and with 25 adolescents with borderline hypertension (BH). Control groups were matched for sex and age. The following morphologic parameters were significantly greater in the SHT group than in the SNT group: interventricular septum (0.54 +/- 0.08 vs 0.49 +/- 0.09 cm/m2; p less than 0.01) and posterior wall (0.54 +/- 0.11 vs 0.50 +/- 0.08 cm/m2; p less than 0.05) thickness, left ventricular mass (125.0 +/- 29.1 vs 109.2 +/- 25.4 gm/m2; p less than 0.005), and cross-sectional area (9.9 +/- 1.8 vs 8.9 +/- 1.6 cm2/m2; p less than 0.005). No significant differences between SHT and BH subjects were observed. Excursion of left ventricular posterior wall was significantly higher in the BH group. No differences were observed between SHT and SNT subjects. These data show that the same kinds of changes in cardiac morphology are present in normotensive subjects with a family history of hypertension and in subjects with borderline hypertension, suggesting that cardiac involvement may precede elevation of blood pressure.

Long-term follow-up in patients with positive exercise test and angiographically normal coronary arteries (syndrome X)

Abstract Our results confirm that patients with carefully diagnosed syndrome X have a good prognosis. We observed no major coronary event or signs and symptoms of impaired cardiac function in any patient. However, in about one third of patients, despite medical treatment, there is residual morbidity with relevant medical and social consequences.

Usefulness of changes in exercise tolerance induced by nitroglycerin in identifying patients with syndrome X.

Two exercise tests, one under basal conditions and one after sublingual nitroglycerin (NTG), were performed in 39 patients with stable angina pectoris--16 with critical coronary stenoses and 23 with normal coronary arteries (syndrome X). Under basal conditions, times at ischemic threshold, at peak exercise, and at complete ECG recovery were similar in the two groups. Peak ST depression was significantly higher in patients with coronary artery disease (CAD). In a similar proportion of patients, ST-segment depression developed earlier or at a low heart rate. Patterns of heart rate, blood pressure, and rate-pressure product during exercise and recovery were also similar. After NTG an increase in the ischemic threshold was observed in a significantly higher proportion of patients with CAD (93.8% vs 39.1%). Furthermore, a subgroup of patients with syndrome X showed a worsening of exercise performance. This suggests that NTG does not directly affect small coronary vessels. Our results confirm that no relevant differences exist in exercise responses between patients with CAD and those with syndrome X under basal conditions. NTG-induced changes in this response could be useful in identifying patients with normal coronary arteries. Moreover, this test could be used as a guide to therapeutic approaches.

Assessment of ventricular function in arterial hypertension with radionuclide ventriculography

Diastolic function of the left ventricle was assessed in 29 untreated patients with mild to moderate hypertension and in 21 normotensive control subjects using gated radionuclide ventriculography. In hypertensive patients, the time to peak filling rate was significantly longer (p less than 0.01) than that in control subjects, and first-third filling fraction and peak filling rate were significantly reduced (p less than 0.001). The ejection fraction and peak ejection rate were also significantly reduced in hypertensive patients (p less than 0.001). No relation was observed between diastolic functional impairment and age, cardiac hypertrophy, or severity of hypertension. Thus, early impairment of ventricular filling is present in hypertension, even in young patients without evidence of cardiac hypertrophy.

Prevalence, Treatment, and Control of Hypertension in the Elderly: Study on Blood Pressure in Elderly Outpatients (SPAA)

The prevalence, quality of care, and degree of control of arterial hypertension have been studied in 3858 elderly outpatients (mean age 72.7 ± 4.9 years) randomly recruited from the practice of 444 general practitioners. Hypertension (defined either as blood pressure [BP] = 160 and/or 90 mmHg and/or the presence of antihypertensive treatment) was found in 67.8% of the screened cohort, with a higher prevalence in females than males (73.1% vs 61.0%) and in the older age group (71.1% in those over 80 years vs 64.8% in the 65–69-year group). The hypertensive status was unknown to both the doctors and the patients in 21.4% of cases. Over 90% of the known hypertensives were on treatment with no age-or sex-related differences, but less than 30% of them had BP < 160/90 mmHg. One drug was prescribed to 50.2% of treated patients, only 5.5% were receiving three or more drugs. Low-dosage treatment schedules were frequently used, often associated with non-daily drug administration. Despite the high proportion of subjects on treatment, hypertension in the elderly we studied seemed to be poorly controlled. The study also documents the need for a more rational approach to detection and control of hypertension in this age group, for whom clearly defined recommendations or criteria are lacking.