Echocardiographic Changes in Systemic Hypertension

Backgroud: Older patients with hypertensive blood pressure have a higher risk of cardiovascular complication when compared to younger hypertensives. Echocardiography is the non invasive procedure of choice in the evaluation of the cardiac effects of systemic hypertension. Objective: To study the echocardiographic changes resulting from systemic hypertension in age group between 61-70 years. Methods: This is an observational study which included 70 individuals presented to the Echocardiography Unit in Ain Shams University Hospital between January 2008 & July 2009. Subjects were divided into 2 groups: Group A included 50 adult hypertensive patients aged between 6170 years not complaining of any other cardiac disease and Group B included 20 healthy non hypertensive individuals of the same age group (control group). Echocardiographic study was done for all selected individuals using 2-D, Mmode and Doppler flow. Results: There was no significant difference between both groups regarding age, sex and risk factors except for body mass index (BMI) which was significantly higher in hypertensive patients. Duration of hypertension ranged from 4-19 years (10.78 ±3.67). Hypertensive patients had statistically significant higher IVS thickness (11.41 vs 9.34mm) (p=0.0001), LV posterior wall thickness (11.47 vs 9.29mm) (p=0.0001), left ventricular mass index (LVMI) (114.74 vs 84.95g/m) (p=0.0001) & larger LA size whether measured in antero-posterior (38.4 vs 35.1mm) (p=0.013), superoinferior (50.63 vs 46.3mm) (p=0.008) or medio-lateral axis (37.15 vs 34.4mm) (p=0.023). Mitral valve calcification [4 (8%) vs 0 (0%)] (p=0.013), mild MR [5 (10%) vs 0 (0%)] (p=0.022), aortic valve calcification [6 (12%) vs 0 (0%)] (p=0.019), sclerosis [12 (24%) vs 1 (5%)] (p=0.001) & mild AR [2 (4%) vs 0 (0%)] (p=0.012) were statistically more affecting hypertensive patients. Size of ascending aorta was significantly larger in hypertensive patients (30.18 vs 27.74mm) (p=0.009). Also, pulmonary artery pressure was significantly elevated in hypertensive patients when measured by PAT (112.8 vs 121.0 msec) (p=0.041) or mean PAP (28.24 vs 24.55mmHg) (p=0.041). There was a statistically significant correlation between the duration of hypertension and LVMI (r=0.846). Conclusion: Hypertension is associated with enlargement of left atrium, dilatation of ascending aorta, development of Correspondence to: Dr. Ramy Raymond, The Department of Cardiology, Faculty of Medicine, Ain Shams University pulmonary hypertension and increase in left ventricular mass which is correlated to the duration of hypertension.