Left ventricular mass and arterial stiffness in a young population with normal and high normal blood pressure

ENNIS IL; BRODA D; PINILLA OA; CINGOLANI HE; ESCUDERO EM

Munich

Congreso; ESC Congress 2012; 2012

The European Society of Cardiology

Introduction: The 2007 European blood pressure classification maintain the same categories in spite of the new concept introduced by Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) as pre-hypertension in 2003. The possibility of overestimating the risk in the individuals place in the low end of this category predisposes to use in the clinical practice the european recommendations, bringing forward a non-resolute question. On the other hand increase in left ventricular mass (LVM) and arterial stiffness (AS) are also recognized as independent risk factors to development cardiovascular events. Therefore we evaluate LVM and AS in a large cohort of young people with normal and high normal pressure in an attempt of contributing to answer the addressed question. Methods: A cross-sectional population-based study was performed using data collected between 2008 and 2011 at La Plata School of Medicine. Normal (N) and High Normal Blood Pressure (HN) were defined according to the 2007 European blood pressure classification. LVM and function (LVF) were evaluated by echocardiogram study. LVM indexed to body size (LVMI) was obtained divided by the allometric signal height2.7. Midwall shortening (MVs) was used to evaluate systolic LVF and the relation between diastolic velocities of mitral annulus (e´/a´) to analyze diastolic LVF. AS was obtained dividing pulse pressure for stroke volume index. Results:  778 students (296 males) 20.55± 0.05 years of age were included. 52% had optimal blood pressure (OBP), 30% normal (N), 12% high normal (HN) and 6% were hypertensive (H). LVMI, was greater in N (30.71±0.44 g/m2.7) and HN (30.56±0.66 g/m2.7) than OBP (28.39±0.29 g/m2.7?p< 0.01). MVs was minor in HN (23.7± 0.53%) than OBP (25.27 ± 0.21%-p<0.02). HN presented a minor relation e´/a´ (1.87±0.05) than N (2.01±0.04 p<0.01) and OBP (2.04±0.03 p<0.01). AS was higher in HN (1.41±0.05 mmHg/cm3/m2) in relation to N (1.22±0.02 mmHg/cm3/m2-p<0.01) and OBP (1.14±0.01 mmHg/cm3/m2-p<0.01). Conclusions The young with HN show increase in LVM and decrease of LVF as larger AS concerning the found in OBP. In turn students with N presented just greater LVM and AS with no changes in LVF in relation to OBP. These findings, at the first decades of life, allow sustaining the higher risk pointed out in general population in relation to their blood pressure. On the other hand and as reply to the initial question, the presence of the major part of these alterations in all no hypertensive individuals with blood pressure over the OBP would indicate similar potential risk as much in N as in NH.