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Hypertension, Vol 11, 457-463, Copyright © 1988 by American Heart Association
G de Simone, L Di Lorenzo, G Costantino, D Moccia, S Buonissimo and O de Divitiis
Forty-three subjects with uncomplicated primary hypertension and without
echocardiographic left ventricular hypertrophy and 54 normotensive
volunteers were studied by two-dimensional targeted M-mode echocardiography
to evaluate systolic function and contractility before the development of
compensatory hypertrophy. The ratio of peak systolic pressure to
end-systolic dimension was used to assess left ventricular performance and
was divided for either posterior wall thickness or cross-sectional area to
generate hypertrophy-independent indices of inotropic state. Fractional
shortening was normal in the hypertensive group, despite the increase in
end-systolic stress. Systolic pressure/dimension ratio was higher in
hypertensive subjects (p less than 0.001), as were hypertrophy-independent
indices of inotropic state (p less than 0.005), which were inversely
correlated to left ventricular mass (p less than 0.001). Values in 11
hypertensive subjects were above the upper confidence limit of the normal
shortening/stress relation, which provides a load-independent measure of
inotropic state. They showed high hypertrophy-independent indices of
inotropic state (p less than 0.01), while the other hypertensive subjects
did not. High fractional shortening, wall stress, and systolic pressure (p
less than 0.01) were found in the subgroup with supernormal performance,
while left ventricular mass was not different from that of other subgroups,
depicting inadequate left ventricular hypertrophy. The duration of
hypertension was the same in the subgroups. Supernormal inotropic state
could be considered one form of primary adaptation to high wall stress that
serves to maintain systolic ventricular performance.
ARTICLES
Supernormal contractility in primary hypertension without left ventricular hypertrophy
Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, University of Naples, Italy.
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