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(Hypertension. 1999;33:1141-1145.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Diastolic Dysfunction and Baroreflex Sensitivity in Hypertension

Maria Vittoria Pitzalis; Andrea Passantino; Francesco Massari; Cinzia Forleo; Cataldo Balducci; Giuseppe Santoro; Filippo Mastropasqua; Gianfranco Antonelli; Paolo Rizzon

From the Institute of Cardiology, University of Bari (M.V.P., C.F., C.B., G.S., G.A., P.R.), and Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Cassano Murge (Ba) (A.P., F. Massari, F. Mastropasqua), Italy.

Correspondence to Maria Vittoria Pitzalis, MD, PhD, FESC, Institute of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. E-mail pitzalis{at}tin.it

Abstract—The determinants of diastolic dysfunction in patients with systemic hypertension are not completely known. To evaluate the possible role of age, arterial blood pressure, and baroreflex heart rate response impairment in causing diastolic dysfunction, we studied 61 patients (42 male; mean±SD age, 43.9±12 years) with newly recognized and therefore previously untreated systemic hypertension. Diastolic dysfunction was evaluated by means of Doppler echocardiography (and diagnosed as such when the early to atrial peak velocity ratio corrected to heart rate was <1), arterial blood pressure by 24-hour ambulatory monitoring, and baroreflex heart rate response by means of the spectral technique ( index) during paced (0.27 Hz) and spontaneous breathing (in a supine position and during tilt). Nineteen patients had diastolic dysfunction, the most powerful predictor of which was age (r=-0.63, P<0.001). The patients with diastolic dysfunction had significantly lower values for spectral baroreflex gain in the high-frequency band than those without (5.2±3 versus 8.4±5 ms/mm Hg during paced breathing, P<0.05; 7.4±4 versus 13.3±7 ms/mm Hg in a supine position, P<0.05; 4.3±4 versus 5±2 ms/mm Hg during tilt, P<NS). Ambulatory blood pressure values were not significantly different in the patients with (137±14 and 89±9 mm Hg) and without (144±11 and 82±24 mm Hg) diastolic dysfunction. In conclusion, age and impaired baroreflex heart rate response (but not pressure overload) are determinants of left ventricular diastolic dysfunction in patients with newly recognized and untreated systemic hypertension.

Key Words: hypertension, systemic • ventricular function, left • baroreflex • blood pressure monitoring, ambulatory

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