Pulmonary hypertension in hypertensive patients: association with diastolic dysfunction and increased pulmonary vascular resistance.
Publication/Presentation Date
4-1-2014
Abstract
BACKGROUND: Pulmonary hypertension (PH) in patients with systemic hypertension and preserved ejection fraction (PEF) has been described. However, the pathophysiology and consequences are not entirely clear. We sought to distinguish the clinical and anatomic features among hypertensive patients with or without coexistent PH.
METHODS: Echocardiograms and records of hypertensive patients with left ventricular (LV) hypertrophy and PEF from January 2009 to January 2011 were reviewed. We identified 174 patients, including 36 with PH (calculated pulmonary artery systolic pressure [PASP] ≥ 35 mmHg), and 138 with normal pulmonary pressures.
RESULTS: Hypertensive patients with PH were older (76 ± 13 vs. 65 ± 13 years, P < 0.0001), more often female (91, 70%), had lower estimated glomerular filtration rate (eGFR) (63 ± 44 vs. 88 ± 48 mL/min, P = 0.002), and higher pro-BNP levels (3141 ± 4253 vs. 1219 ± 1900 pg/mL, P = 0.003). PH patients also had larger left atrial areas (23.7 ± 3.8 vs. 20.8 ± 4.6 cm(2) , P = 0.002), evidence of diastolic dysfunction (i.e., septal E/e' 17.6 ± 8.6 vs. 12.7 ± 4.4, P = 0.0005), and higher calculated peripheral vascular resistance (PVR) (2.3 ± 1.1 vs. 1.6 ± 0.4, P < 0.0001). Both PVR and septal E/e' showed strong linear correlation with PASP (P < 0.0001 and P < 0.0001, respectively).
CONCLUSIONS: Hypertension in elderly patients is frequently complicated by LV diastolic dysfunction and secondary PH. These hypertensive patients tended to have reduced renal function and higher pro-BNP. Because of the known morbidity and mortality associated with PH, these observations have potentially important implications for target medical therapy.
Volume
31
Issue
4
First Page
442
Last Page
448
ISSN
1540-8175
Published In/Presented At
Mukherjee, M., Mehta, N. K., Connolly, J. J., Dusaj, R. S., Choi, B. G., Katz, R. J., & Lewis, J. F. (2014). Pulmonary hypertension in hypertensive patients: association with diastolic dysfunction and increased pulmonary vascular resistance. Echocardiography (Mount Kisco, N.Y.), 31(4), 442–448. https://doi.org/10.1111/echo.12393
Disciplines
Medicine and Health Sciences
PubMedID
24199601
Department(s)
Department of Medicine
Document Type
Article