Hypertensive Hypertrophic Cardiomyopathy of the Elderly

• Published in: The New England journal of medicine Vol. 312; no. 5; pp. 277 - 283
• Main Authors: Topol, Eric J, Traill, Thomas A, Fortuin, Nicholas J
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 31.01.1985
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Calcium antagonists; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Cardiomyopathy; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Hypertrophic - drug therapy; Cardiomyopathy, Hypertrophic - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary artery disease; Coronary Disease - complications; Dyspnea; Echocardiography; Female; Geriatrics; Heart diseases; Heart Failure - physiopathology; Humans; Hypertension; Hypertension - complications; Hypertrophy; Ischemia; Male; Medical sciences; Middle Aged; Older people; Pain; Respiration; Stroke Volume; Vasodilator Agents - adverse effects; Ventricle; Human; Heart; Hypertension; Elderly; Heart disease; Hypertrophy
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198501313120504

Using echocardiography, we identified 21 patients with a syndrome that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. Thirteen of the patients presented with dyspnea or chest pain. All patients studied had a history of hypertension and were compared with normotensive controls matched for age and sex. The patients were elderly (mean age, 73.3 years), predominantly female (16 patients), and mostly black (15 patients). Their cardiac function was characterized by excessive left ventricular emptying (ejection fraction on two-dimensional echocardiography [patients vs. controls], 79±4 vs. 59±5 per cent, P<0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279±25 vs. 160±45 msec, P<0.001) and reduced peak diastolic dimension increase (11±4 vs. 16±5 cm per second, P<0.05). In spite of the clinical presentation of heart failure, all of 9 patients receiving either beta-receptor antagonists or calcium-channel blocking agents obtained symptomatic relief, whereas 6 of 12 patients receiving vasodilator medications had severe hypotensive reactions, including one death. We conclude that this unique subset of hypertensive patients has a clinical syndrome that warrants recognition and tailored management. (N Engl J Med 1985; 312:277–83.) long-standing hypertension is a frequent precursor of congestive heart failure. When heart failure occurs, the left ventricle is usually hypertrophied and dilated and indexes of systolic function, such as ejection fraction, are reduced. Treatment is aimed at improving systolic function by administering inotropic and afterload-reducing agents. We have identified a group of elderly patients with mild to moderate hypertension presenting with pulmonary congestion whose ventricular function differed greatly from the traditional view and who required a different therapeutic approach. These patients had severe concentric left ventricular hypertrophy but a reduced left ventricular cavity size and increased indexes of systolic function. . . .