Pulmonary Hypertension in Hypertensive Patients: Association with Diastolic Dysfunction and Increased Pulmonary Vascular Resistance

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 31; no. 4; pp. 442 - 448
• Main Authors: Mukherjee, Monica, Mehta, Nishaki K., Connolly, James J., Dusaj, Raman S., Choi, Brian G., Katz, Richard J., Lewis, Jannet F.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.04.2014
• Subjects: Age Factors; Aged; Aged, 80 and over; Cohort Studies; diastolic dysfunction; echocardiography; Echocardiography - methods; elderly; Female; Follow-Up Studies; Heart Failure, Diastolic - complications; Heart Failure, Diastolic - diagnostic imaging; Humans; hypertension; Hypertension - complications; Hypertension - diagnosis; Hypertension - diagnostic imaging; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - diagnostic imaging; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Linear Models; Male; Middle Aged; pulmonary hypertension; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Statistics, Nonparametric; Stroke Volume - physiology; Time Factors; Vascular Resistance - physiology; diastolic dysfunction; hypertension; elderly; pulmonary hypertension; echocardiography
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.12393

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 cm2, 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.