Indices of Pulse Wave Analysis Are Better Predictors of Left Ventricular Mass Reduction Than Cuff Pressure

• Published in: American journal of hypertension Vol. 20; no. 4; pp. 378 - 384
• Main Authors: Hashimoto, Junichiro, Imai, Yutaka, O’Rourke, Michael F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2007; Oxford University Press; Elsevier Science
• Subjects: Adult; Aged; Antihypertensive Agents - therapeutic use; antihypertensive therapy; Aorta - physiopathology; Arterial hypertension. Arterial hypotension; augmentation index; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity - physiology; Blood Pressure - physiology; Cardiology. Vascular system; Cardiovascular system; Carotid Arteries - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Femoral Artery - physiopathology; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Left ventricular mass; Male; Manometry - instrumentation; Manometry - methods; Medical sciences; Middle Aged; Multivariate Analysis; Oscillometry - instrumentation; Oscillometry - methods; Predictive Value of Tests; Prospective Studies; pulse wave; Stroke Volume - physiology; Ventricular Remodeling - physiology; wave reflection; Left ventricular mass; antihypertensive therapy; wave reflection; augmentation index; pulse wave; Hypertension; Treatment; Antihypertensive agent; Cardiovascular disease; Left ventricle
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2006.09.019

Studies have required large numbers of patients to associate regression of left ventricular (LV) mass with a decrease in brachial cuff blood pressure (BP) in the treatment of hypertension. Hence, we prospectively examined potential superiority of pulse wave analysis over conventional BP measurement in predicting treatment-induced LV mass reduction. Forty-six untreated patients (mean age, 56 ± 7 years) with hypertension received standard medical treatment based on international guidelines. Echocardiography and measurements of various LV load indices were made before and after 1 year of treatment. Antihypertensive treatment significantly ( P < .05) reduced LV load, manifest by a decrease in measured brachial BP, estimated aortic BP, carotid–femoral pulse wave velocity (PWV cf), aortic augmentation index (AI a), aortic augmented pressure (AugP), and radial augmentation index (AI r). These changes were accompanied by significant reduction in LV mass index (LVMI) and improvements in systolic ejection fraction and diastolic early-to-atrial ratio of transmitral flow velocities. The treatment-induced LVMI change was not correlated with changes in brachial BP or PWV cf, but was closely correlated with factors influenced by wave reflection—changes in AI a, AI r, AugP, and aorta-to-arm pulse pressure amplification. On multivariate analysis, AI a change was the strongest determinant of LVMI change, independent of brachial BP and PWV cf changes (β = 0.51, P < .001). Estimated subject numbers required for predicting a significant LVMI reduction were far less when wave reflection-related factors were used rather than conventional bracial BP. These results suggest that reduction in wave reflection is an important therapeutic strategy for reducing LV mass, which can be predicted with modest subject numbers.