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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was undertaken to define the relation between the extent of left ventricular (LV) hypertrophy and ventricular systolic performance in patients with chronic systemic hypertension. Ninety patients with chronic systemic hypertension were compared with 41 normal subjects as determined by angiography. LV mass was estimated from the M-mode echocardiogram. Patients were separated into 3 groups: those with LV mass of less than 2 (group I, n = 58), 2 to 4 (group II, n = 21) and more than 4 (group III, n = 11) standard deviations above mean normal. The ratio of preejection period to LV ejection time (PEP/LVET), percent shortening of the echocardiographic internal diameter (% delta D) and velocity of circumferential shortening (Vcf) were used as indexes of LV systolic performance. The frequency of abnormality, expressed as percent of patients in groups I, II and III, was 33%, 55% and 85% for PEP/LVET, 15%, 35% and 72% for % delta D, and 0%, 15% and 55% for Vcf. For each group PEP/LVET was the most frequently abnormal measure and Vcf was the least frequent abnormality. Calculation of peak and end-systolic wall stress was used as an index of the adequacy of LV hypertrophy. This index was significantly reduced in group I, did not differ from control in group II and was significantly increased in group III, indicating that hypertrophy was appropriate to wall tension in groups I and II. It is concluded that the occurrence of LV dysfunction with increasing LV mass in patients with moderate LV hypertrophy (group I and II) reflects a deficiency in intrinsic contractile performance of the hypertrophied myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricular mass and systolic performance in chronic systemic hypertension. 293 31

To investigate the predictive value of exercise tests and diastolic function measurements for the progression of left ventricular hypertrophy, symptom-limited treadmill stress testing and echocardiography were performed before and after a follow-up period of 3.5 years in 47 mild hypertensive men aged 42 +/- 2 years. The men were classified into three groups by the progression of the left ventricular mass index (%LVMI) during the observation, i.e. (LVMI after follow-up) - (LVMI before follow-up)/(LVMI before follow-up). The high-progression group (n = 13) had a %LVMI exceeding mean +/- 2/3s.d. of all subjects; the low-progression group (n = 21) had a %LVMI within mean +/- 2/3s.d. and the non-progression group (n = 13) had a %LVMI less than mean -2/3s.d. At the beginning of the observation, age, blood pressure at rest, LVMI, ejection fraction, mean velocity of circumferential fibre shortening, peak shortening rate and systolic time intervals (ET/PEP, ratio of ejection time to pre-ejection period) were similar among the three groups. However, the high-progression group showed a higher systolic pressure at peak exercise, a lower peak filling rate and a longer time to peak filling rate (TPFR) as corrected by the R-R interval of the ECG. These data suggest that systolic pressure at peak exercise and echocardiographically assessed diastolic function are useful in predicting the progression of cardiac involvement in mild hypertension.
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PMID:Prediction of the progression of cardiac hypertrophy in middle-aged mild hypertensives. 297 81

Chronic effects of captopril were studied in 29 patients (age, 4 months to 16 years; mean, 6.9 years) suffering from digitalis and diuretic resistant congestive heart failure (CHF) or hypertension of different etiology. Twenty two patients with CHF (13 dilated, 4 restrictive cardiomyopathy, 5 congenital heart defects) and 7 cases with hypertension were treated for 1 to 31 months (mean, 9 months). The dose of captopril varied from 1 to 3 mg/kg/day (mean, 2.2 mg) in CHF and from 1.1 to 6.8 mg/kg/day (mean, 3.7 mg) in hypertension. In CHF digoxin therapy was maintained while the dose of diuretics could be reduced or discontinued. In 4 severely hypertensive patients the addition of a diuretic or beta blockers was necessary. In CHF clinical improvement was observed in 13 patients (59%), while there was no response in 4 and 5 patients died. The survivors exhibited a significant decrease of the cardiothoracic index (p less than 0.05), the PEP/LVET ratio (p less than 0.05) and an increase of the echocardiographic linear ejection fraction (p less than 0.001). If hypertension was present, blood pressure decreased in all patients (p less than 0.05). Captopril was well tolerated by all patients except one who developed anaemia. This side effect disappeared after having discontinued the drug. These findings suggest that captopril is of benefit in controlling chronic CHF. Captopril alone or in combination with other drugs is effective in the management of severe hypertension.
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PMID:Indications and effects of captopril therapy in childhood. 307 97

We studied 20 children with congenital heart disease using Echo-Phonocardiographic techniques to determine the presence and magnitude of pulmonary arterial hypertension. The results were compared with those obtained by catheterization. There was a significant correlation between the pulmonary arterial systolic pressure (PSP) estimated from the right ventricular isovolumetric relaxation period and the PSP from the catheterization (r = 0.92). The ratio preejection period /right ventricular ejection time (PEP/RVET) identified the patients (PEP/RVET greater than or equal to 0.30) with a PSP mean value = 64.5 mmHg (p less than 0.01). The presence of a systolic notch on the pulmonary valve echogram distinguished the group with a PSP mean value = 60 mmHg (p less than 0.005). There was a poor correlation between the depth of the "a" wave and the E-F slope of the pulmonary valve echogram and the catheterization PSP (r = -0.50 and r = -0.40, respectively). The interval PR from the electrocardiogram minus the distance AC from the tricuspid valve echogram had a poor correlation with the right ventricular end diastolic pressure (r = 0.57). We conclude that there are some Echo-Phonocardiographic signs which are very useful in the diagnosis and measurement of pulmonary arterial hypertension in children with congenital heart disease.
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PMID:[Quantification of pulmonary arterial hypertension by phonocardiography and M-mode echocardiography in children with congenital cardiopathies]. 316 66

The pathogenesis of alcohol cardiomyopathy is obscure. Because systemic hypertension is observed in one-third of alcoholics, the relation of this finding to left ventricular (LV) function was analyzed in 66 alcoholics (26 with a blood pressure of 160/95 mm Hg or higher) 4 to 5 days after alcohol withdrawal. Hypertensive alcoholics had a more abnormal ratio of preejection period/LV ejection time (PEP/ET) (0.398 +/- 0.01 vs 0.35 +/- 0.01, p less than 0.02) than normotensive alcoholics (matched normal 0.290 +/- 0.01). Hypertensive alcoholics (transitory hypertension) with blood pressures of 120/80 mm Hg or less at time of study also had more abnormal PEP/LVET than matched normotensive alcoholics (0.415 +/- 0.03 vs 0.331 +/- 0.01, p less than 0.05). In both hypertensive (77 +/- 6 dynes/cm2 X 10(3)) and normotensive alcoholics (67 +/- 4 dynes/cm2 X 10(3) LV stress was elevated (normal 46 +/- 3 dynes/cm2 X 10(3), both p less than 0.02). However, LV mass was not increased (hypertensive 96 +/- 4 g/m2; vs normotensive 100 +/- 4 g/m2; (normal 92 +/- 5 g/m2), resulting in a markedly increased stress to mass ratio (hypertensive 0.8 +/- 0.06; Normal 0.05 +/- 0.05, p less than 0.02). Hypertensive alcoholics also had LV "hyperfunction," with an increased stress/LV end-systolic volume ratio (1.7 +/- 0.1 vs 1.3 +/- 0.1 dynes/cm2 X 10(3)/ml, p less than 0.02). Thus, hypertensive alcoholics, even those with transitory hypertension, have more abnormal cardiac function than normotensive alcoholics. Presence of hypertension with hyperdynamic LV features may be a prelude to heart failure.
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PMID:Cardiac function in alcohol-associated systemic hypertension. 394 13

As part of the Veterans Administration cooperative studies on antihypertensive agents, systolic time intervals (STIs) were recorded before and after 2 or 4 weeks of treatment with hydrochlorothiazide (HCTZ) alone in 320 asymptomatic patients with mild to moderate hypertension. After treatment with HCTZ, left ventricular ejection time corrected for heart rate (delta LVET) was significantly reduced. This decrease is consistent with other hemodynamic observations indicating a reduced preload and stroke volume after administration of thiazides. Electromechanical systole corrected for heart rate (delta QS2) decreased, while the ratio of preejection period to LVET (PEP/LVET) increased, reflecting reduced left ventricular function. PEP did not change. Four step 2 drugs--hydralazine, prazosin, oxprenolol and propranolol--were then added randomly to HCTZ and further recordings of STIs were taken at 1 and 6 months after administration of these drugs. The delta LVET and delta QS2 increased and PEP/LVET decreased, suggesting improved left ventricular function after administration of all 4 agents. These changes may have been due to the added agents or to the recovery of cardiac output that occurs independently during long-term treatment with thiazide diuretic drugs alone. PEP decreased slightly after hydralazine and prazosin and increased slightly after treatment with the beta-blocking drugs, although none of these changes were significant except those during hydralazine treatment. Processing of the STIs was greatly facilitated by the automated system for recording and analyzing the measurements.
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PMID:Serial measurements of systolic time intervals during treatment with hydrochlorothiazide alone and combined with other antihypertensive agents. 396 70

49 diabetics (D) (26 IDD and 23 NIDD) were compared to 32 controls (C). Absence of ischemic cardiopathy (IC) was confirmed by routine investigations and noninvasive cardiovascular techniques, including an exercise ECG using 12 leads and a thallium 201 scintigraphy. Our results show: a) a prolonged mean isovolumetric relaxation time (IVRT) as studied by the M mode echocardiography and phonomechanography: D = 0,10 sec +/- 0,04; C = 0,05 sec +/- 0,02; p less than 0,0001; b) a reduced mean EF slope: D = 97,48 +/- 37,08 mm / sec; C = 125,68 +/- 34,35; p less than 0,005; c) a high mean Weissler index (ratio of PEP to LVET): D = 40 +/- 0,08; C = 33 +/- 0,05; p less than 0,01. IVRT and EF slope abnormalities are related to increased myocardial stiffness and impaired LV compliance. In the absence of changes in preload and afterload, the high Weissler index reflects impaired contractility of the myocardium. These abnormalities are related neither to the duration of diabetes nor to the presence or severity of the complications. With the M mode echocardiography, mean diastolic and systolic thickness of the septum is greater in D with retinopathy than in C (p less than 0,005 and p less than 0,03 respectively); mean diastolic and systolic thickness of the posterior wall is greater in NIDD than in C (p less than 0,001 and p less than 0,025). We conclude that there is evidence of left ventricular functional abnormalities specific to diabetes and unrelated to IC and hypertension. Our findings support the hypothesis that they may be due to metabolic disorders and/or myocardial microangiopathy.
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PMID:[Existence of asymptomatic changes in left ventricular function in the diabetic. Noninvasive study]. 400 44

Systolic time intervals (STI) and echocardiography were recorded in 133 (70 men, 63 women) newly diagnosed non-insulin-dependent diabetics aged 45-64 years and in 144 (62 men, 82 women) non-diabetic control subjects of the same age. Both male and female diabetics had significantly increased pre-ejection period/left ventricular ejection time ratio (PEP/LVET) in STI as compared with the respective non-diabetic control subjects. Male diabetics showed a reduced ejection fraction (EF) in echocardiography, but no significant difference was found in this respect between female diabetics and controls. A significant negative correlation was found between 2-hour postglucose serum insulin level and EF in male and female diabetics. After adjusting for the effect of age, coronary heart disease, hypertension, obesity and haemoglobin concentration, male diabetics still had a higher PEP/LVET ratio and a lower EF than male controls. In women, no significant differences were found between diabetics and controls in the PEP/LVET ratio or EF adjusted for the above factors. The results of this study are compatible with the view that impaired left ventricular function may be an early phenomenon in the clinical course of non-insulin-dependent diabetes.
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PMID:Left ventricular function in newly diagnosed non-insulin-dependent (type 2) diabetics evaluated by systolic time intervals and echocardiography. 401 29

Systolic time intervals (STI) were recorded at rest and during isometric exercise (IHG) in 20 hypertensive outpatients, WHO Stage 1 or 2. In a double-blind crossover study, slow-release metoprolol 200 mg once daily and matched placebo were given for 4 weeks each, at the end of a 2-week placebo washout. Blood pressure and STI were taken in the last day of washout and of either crossover period. Treatment decreased blood pressure and heart rate values at rest and on peak IHG; it didn't modify preejection period index (PEPI), left ventricular ejection time index (LVETI), and their ratio at rest, but decreased the ratio between diastolic blood pressure and PEPI (DBP/PEPI ratio) at rest and on peak IHG and lengthened the PEPI at peak IHG. Resting PEPI values on placebo treatment showed a negative correlation with systolic (r = -0.72) as well as diastolic (r = -0.80) pressure reduction on slow-release metoprolol as compared with placebo treatment. The PEP/LVET ratio at rest on placebo treatment showed a negative correlation with systolic (r = -0.78) as well as diastolic (r = -0.82) pressure reduction at rest on metoprolol compared with placebo treatment. Patients with a resting PEP/LVET ratio less than 0.43 showed a reduction in both systolic and diastolic pressure approximating or exceeding 20 mm Hg, whereas patients with a PEP/LVET ratio greater than 0.47 showed a decrease in systolic and diastolic blood pressure of less than 10 mm Hg. In patients with a PEP/LVET ratio of 0.43 to 0.47 (50% of the trial population), STI didn't show any correlation with the pressure response to beta-blockade. A positive correlation was found between the DBP/PEPI ratio at rest on placebo treatment and systolic (r = 0.56) as well as diastolic (r = 0.76) pressure reduction at rest on slow-release metoprolol compared with placebo treatment. Thus, STI appeared as promising predictors of the magnitude of blood pressure response to sustained beta-blocking therapy in mild-to-moderate essential hypertension, mostly in patients with a resting PEP/LVET ratio less then 0.43 or greater then 0.47.
Hypertension
PMID:Systolic time intervals as possible predictors of pressure response to sustained beta-adrenergic blockade in arterial hypertension. A within-patient, placebo-controlled study. 633 19

26 patients with moderate hypertension and no signs of heart failure were treated with metoprolol, labetalol or prazosin. Systolic time intervals (STI) were measured before and after several months of treatment. During treatment with metoprolol, a decrease in the preejection period index (PEPI), and preejection period/left ventricular ejection time ratio (PEP/LVET), was found. During treatment with labetalol or prazosin, a minor decrease in PEPI was observed, so that a significant decrease in PEP/LVET was not obtained. A decrease in PEPI and PEP/LVET may be due to improved cardiac performance, but in the given type of patients it is more dependent on the reduction in afterload. The STI measurement is less sensitive in discerning different mechanisms involved in lowering the blood pressure and cannot therefore be used for selecting the optimal antihypertensive drug.
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PMID:The use of systolic time intervals in the evaluation of antihypertensive treatment with metoprolol, labetalol and prazosin. 665 28


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