Κατεύθυνση Μονάδες Εντατικής Θεραπείας-Καρδιολογική Νοσηλευτική
Library of the School of Health Sciences

2014-11-24

2014

Φλέσσας Δημήτριος

Αναπληρωτής Καθηγητής Κων/νος Τσιούφης, Καθηγήτρια Ελένη Κυρίτση, Καθηγητής Χριστόδουλος Στεφανάδης

Μεταβολές του μεγέθους του αριστερού κόλπου σε σχέση με τις μεταβολές των δεικτών των οργάνων στόχων μετά από μακροχρόνια παρακολούθηση ασθενών με αρτηριακή υπέρταση

Greek

Objective: We sought to identify the relationship of left atrial variations in
size in essential hypertensives with the target organs damage and whether the
regression of LA size has an impact on diastolic dysfunction. We also
investigated the parameters of 24h ABPM which carry prognostic role in the long
term regression of the target organs lesions.
Design and methods: We followed up 285 consecutive patients(average age 50.6
years, 65.4% men) with essential hypertension as defined according to recent
recommendations, free of cardiovascular disease, for a mean period of 3.5
years. All subjects underwent complete echocardiographic study for
determination of left ventricular diastolic function, with assessment of
transmitral flow (Ε, Α , Ε/Α) and tissue Doppler (Em/Am) indices, to 24h ABPM,
to routine blood sampling and to assessment of metabolic profile, both at
baseline and at follow up.
Results: Three groups were identified depending on regulation of BP. The
incidence of uncontrolled office BP was 40.9%, for uncontrolled office systolic
BP was 28.3% and fοr uncontrolled office diastolic BP was 28.7%. Patients of
the first group at the end of the follow up period exhibited worse metabolic
profile (p=0.022) while systolic BP measurements both office and ABPM have
clearly deteriorated (Οff SBP: p<0.001, 24h SBP:p<0.001). Moreover there is
worsening in diastolic dysfunction (TDIEa: p<0.03) and LA appears with slightly
increased size(baseline p=0.11 και follow up p=0.1). Patients of the second
group from the beginning of the study have increased systolic BP both office
(p<0.001) and 24h ABPM (p<0.001), increased LV (LVEDD p=0.029 and LVM p=0.037).
At the end of the follow up, office systolic BP ( p<0.001), PP (p<0.001) and
24h systolic ABPM (p<0.001) exhibit statistically significant decrease. These
patients have the more significant target organ lesions with with increased
LVM (p<0.01), diastolic dysfunction (ΤDIEa: p=0.005 and E/Em: p=0.005), with
left atrial increase statistically significant in size (p=0.054) and volume
(p=0.051). Patients of the third group are younger in age (p<0.001), with worse
BMI (waist: p=0.09, waist to hip ratio: p=0.09) and at the end of the follow up
both office systolic and diastolic BP remain worsened and no statistically
significant difference for LA (p=0.31 at the end of the follow up) –which doesn’
t show any regression- and diastolic dysfunction was observed. Linear
regression analysis indicated that systolic BP was the strongest factor for the
lack of regression of target organs damage.
Conclusions: Uncontrolled systolic BP without uncontrolled diastolic BP is a
parameter strong enough for the lack of regression of targer organ damage. As
long as systolic BP is uncontrolled, LVM will not be affected and due to the
aging, diastolic dysfunction and increased LA size will be added in an
aggravating manner. LA in all 3 groups remains with increased size and with no
regression, even for the controlled groups. This findings underline the
importance of the 24h ABPM in hypertensive patients and the prognostic
significance of the uncontrolled systolic BP in the lack of targer organs
damage regression.

Hypertension, Target organ damage, Left atrium, Regression, Diastolic dysfunction

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https://pergamos.lib.uoa.gr/uoa/dl/object/1312632