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European Heart Journal 1982 3(3):246-254;
Copyright © 1982 by the European Society of Cardiology.
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© 1982 by The European Society of Cardiology

Cardiac involvement in hypertension

A non-invasive study of patients with previous malignant hypertension and ‘benign’ hypertension

T. GUDBRANDSSON, R. SIVERTSSON, H. HERLITZ and L. HANSSON

Hypertension Section, Departments of Medicine and Clinical Physiology, Östra Hospital Goteborg, Sweden
Department of Medicine I, Sahlgren's Hospital, University ofGöteborg Göteborg, Sweden

Received 16 July 1981; revised 15 September 1981; .

Requests for reprints to: Thorkell Gudbrandsson, M.D., Department of Medicine, Ostra Hospital, S-416 85 Goteborg, Sweden.

Abstract

Non-invasive assessment of cardiac hypertrophy and function was made in 15 male patients with previous malignant hypertension as well as in 15 matched patients with ‘benign’ hypertension and 15 matched normotensive control subjects. In the group with previous malignant hypertension, echocardiography revealed increased (>1.3 cm) thickness of the interventricular septum in all but one patient (93%) as compared to 67% in the group with ‘benign’ hypertension and 7% in the control subjects. Other indices of left ventricular hypertrophy, including left ventricular mass, were also more pronounced in the hypertensive groups and significantly higher than in the control subjects.

Conventional ECG appeared to be much less sensitive in detecting left ventricular hypertrophy, in particular the traditional ‘combined LVH criteria’ (high voltage+ST-T changes) which were positive in only 27% of the patients with previous malignant hypertension as compared to 0% in the other two groups. With less stringent and less specific criteria the diagnostic yield could be increased to 60 and 40% in the two hypertensive groups.

Regarding left ventricular performance, an increased a/H ratio (15.4, 13.4 and 8.5%, respectively) and a lower E-F slope (67, 94 and 114 mm/s, respectively) indicated abnormal diastolic function in the hypertensive groups. On the other hand, indices of systolic function (ejection fraction and mean velocity of circumferential fiber shortening) were found to be normal in the hypertensive groups. In the patients with previous malignant hypertension these indices appeared to be ‘supranormal’ [i.e. significantly higher values were found (77 v. 70%, P <0.01 and 1.31 v. 1.08 circ/s, P<0.01, respectively) than in the normotensive control subjects].

Key Words: Previous malignant hypertension • echocardiography • left ventricular hypertrophy • cardiac performance • antihypertensive therapy


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