Prevalence and Determinants of Cardiac and Vascular Hypertrophy in Hypertension

Abstract

Abstract Hypertrophy of the capacitance arteries has recently been documented in hypertensive patients by noninvasive ultrasound techniques. To better define the prevalence and determinants of vascular hypertrophy and its potential association with ventricular hypertrophy in hypertension, we compared carotid and cardiac ultrasound findings in 172 normotensive and 172 unmedicated hypertensive subjects matched for age and sex. Despite similar body size, hypertension was associated with increased left ventricular wall thicknesses, mass, and mass index (89 versus 80 g/m 2 , P <.0001 for all comparisons) and increased carotid wall thickness (0.82 versus 0.77 mm) and cross-sectional area (17.1 versus 15.3 mm 2 , P <.005 for both comparisons). Among the 172 normotensive subjects, left ventricular hypertrophy was noted in 9 (5.2%) and arterial hypertrophy was found in 9 (5.2%), whereas ventricular hypertrophy was found in 21 (12.2%) and arterial hypertrophy in 19 (11%) hypertensive subjects. Arterial hypertrophy was found in 9% of hypertensive subjects with normal ventricular mass and in 24% with left ventricular hypertrophy ( P <.05). Among hypertensive subjects carotid wall thickness and cross-sectional area were most strongly related to age and systolic pressure ( P <.0001 for all comparisons), with little contribution from body size. Carotid relative wall thickness was only related to increasing age ( P <.01). In contrast, left ventricular wall thickness and mass were strongly related to body size and systolic pressure ( P <.0001 for all comparisons) but not to age ( P =NS). Thus, among otherwise healthy, asymptomatic hypertensive subjects, left ventricular and arterial hypertrophy are similarly prevalent (when the latter is defined by methods that take into account the influence of aging) and are associated with each other. Although both arterial and left ventricular size are strongly related to blood pressure, aging is the most important determinant of arterial size, even in hypertension, whereas body size is the most important determinant of left ventricular mass.