Document Detail


Arterioventricular coupling and ventricular efficiency after antihypertensive therapy: a noninvasive prospective study.
MedLine Citation:
PMID:  18158354     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with hypertension exhibit impaired energetic coupling between the ventricle and the arterial system, leading to reduced cardiac mechanic efficiency and exercise capacity. We tested whether blood pressure normalization with current antihypertensive therapy can improve arterioventricular coupling. Eighteen hypertensive patients without other cardiovascular disease were examined before and after antihypertensive therapy. Transthoracic echocardiography was performed. Central aortic pressure waveforms, including end-systolic pressure, were derived from radial artery applanation tonometry. Afterload was increased with isometric handgrip exercise. Central aortic end-systolic pressure and ventricular volumes at rest and handgrip were used to calculate ventricular elastance, effective arterial elastance, arterioventricular coupling (effective arterial elastance/ventricular elastance), and mechanical efficiency. After 142+/-67 days, systolic blood pressure decreased from 150.9+/-14.6 to 119.8+/-9.2 mm Hg (P<0.00001), diastolic blood pressure from 85.9+/-14.8 to 68.8+/-8.4 mm Hg (P=0.00002), and cardiac output from 5.8+/-1.7 to 4.9+/-1.8 L/min (P=0.03). Resting left ventricular end-systolic volume, ejection fraction, and septal thickness did not change. Ventricular elastance increased from 1.7+/-1.0 to 3.2+/-1.4 mm Hg/mL (P=0.00002), whereas effective arterial elastance decreased from 1.4+/-0.5 to 1.2+/-0.4 mm Hg/mL (P=0.02). Effective arterial elastance/ventricular elastance decreased in all patients, from 1.1+/-0.8 to 0.4+/-0.2 (P=0.0002). Efficiency improved at rest (72.9+/-5.8% versus 83.5+/-5.7%; P<0.00001) and during handgrip (63.5+/-7.8% versus 78.9+/-7.1%; P<0.00001). In hypertensive patients, optimal brachial and central blood pressure reduction shifts arterioventricular coupling from cardiac output maximization to ventricular mechanical efficiency optimization. This occurs before significant changes in ventricular geometry and may be responsible for early clinical improvements.
Authors:
Martin Osranek; John H Eisenach; Bijoy K Khandheria; Krishnaswamy Chandrasekaran; James B Seward; Marek Belohlavek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-12-24
Journal Detail:
Title:  Hypertension     Volume:  51     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-02-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  275-81     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. osranek.martin@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use*
Aorta / physiopathology
Arteries / drug effects,  physiopathology*
Blood Pressure / drug effects*
Brachial Artery / physiopathology
Echocardiography
Elasticity
Female
Hand Strength
Humans
Hypertension / drug therapy*,  physiopathology*,  ultrasonography
Male
Middle Aged
Prospective Studies
Rest
Stroke Volume
Ventricular Function, Left / drug effects*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
Hypertension. 2008 Feb;51(2):179-81   [PMID:  18158347 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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