Abstract

ABSTRACT

Introduction: Uncontrolled hypertension increases the total peripheral vascular resistance

considered as a silent vascular disease, with metabolic disorders, affecting different organs,

inducing pathological changes. Among them, heart damage, progressing from left ventricular

hypertrophy to heart failure by altering the left ventricular ejection fraction.

Objective: To determine the prevalence of left ventricular hypertrophy and left ventricular

ejection fraction by echocardiography in hypertensive patients in the area of Silver Spring, MD

and Washington DC.

Patients and methods: The study was descriptive, retrospective, transversal, and observational

variables control, in patients requested echocardiography studies (n = 218) during the established

period, 78.4% Latin American, 44% male. It was observed in the database of the Integrated

Prevention Unit.

Results: It was presented 41.4% of left ventricular hypertrophy among hypertensive. Among the

hypertensive patients of 70 years (94%) it was found 46.80% of left ventricular hypertrophy, all

of 70 years without hypertension, did not present left ventricular hypertrophy, there was

prevalence of hypertension and left ventricular hypertrophy in the older women. The left

ventricular ejection fraction of hypertensive patients was 97.6% normal, 1.6% slightly, 0.0%

moderate and 0.8% severe.

Conclusions: The prevalence of left ventricular hypertrophy in hypertensive patients was 41.4%,

and normal left ventricular ejection fraction is prevalent in the elderly without hypertension.

Keywords: Hypertension - Left Ventricular Hypertrophy - Ejection Fraction -

Echocardiography.

INTRODUCTION

High blood pressure, known as the silent disease, is probably the most important public issue in

developed countries, is common, asymptomatic and easily treated, but with lethal complications

if not treated.1 Over 74 million Americans suffer from hypertension and at least 16 million of

them do not even know. If we combine the data from developed and developing countries the

high blood pressure (HTN) affects 25-35% of the adult population. This figure increases to 60-

70% in those over 70 years.2, 3

The Framingham Heart Study revealed a significant increase in

the prevalence of left ventricular hypertrophy (LVH) in elderly patients with hypertension

(HTN).4

Systemic HTN is defined as the increase in pressures on the arterial walls by blood flow. In case

of pathological situations where there is increased afterload, the heart undergoes LVH to reduce

tension in the walls under the law of Laplace.5, 6

Echocardiography has been the standard procedure for calculating LVH more than 25 years, 13

provides information on the morphology, ventricular cavity, ventricular thickness, left

ventricular ejection fraction (LVEF), contraction of different segments and, as consequence of

this, of the global systolic function, an important factor in morbidity and mortality in

hypertension patients. Clinical and epidemiological studies demonstrate the diagnostic and

prognostic utility of echocardiography in hypertension, especially in the impact of LVH and

LVEF detected by echocardiography.1, 7

The LVH determined mainly by the increased size of

myocyte is the most common heart disease in hypertensive patients, and increases the risk of

premature cardiovascular events or death.8, 15

LVH is an important prognostic marker, and

monitoring a hypertensive patient should be followed with the study ecocardiográfico.18

General Objective

Determine the prevalence of LVH by echocardiography in hypertensive patients in the area of

Silver Spring, MD and Washington DC.

End Points

Observe the prevalence of LVH in hypertensive patients between 70 years or older and

younger men and women.

Compare the value of LVEF in hypertensive patients in relation to non-hypertensive

patients assessed by echocardiogram during the study period.

MATERIAL PATIENTS AND METHODS

Scope, duration of the study

The study was conducted over a period of seven months, from July 2010 until January 2011, in

the Francisco A. Matheus Clinic in Silver Spring, MD.

Methodological Design

The study was descriptive, retrospective, cross-temporal, and with control of observational

variables.

Study Population

The study samples were all hypertensive and non-hypertensive patients with echocardiography

study done. The inclusion criterion of the group was the medical study diagnostic

echocardiography of LVH and to have hypertension. Patients who did not wish to participate of

the study were excluded.

Sample Identification

The universe consisted of two hundred and eighteen (n = 218) echocardiography studies of sexes,

78.4% Latin American and 44% male.

Operationalization of variables

It was recorded in a Microsoft Access table the patients who were studied with

echocardiography, hypertensive patients were determined by mercury sphygmomanometer,

verified at the time they were in the clinic for consultation and the register of medical records.

LVH it was based on male values and cardiac ultrasound criteria was based on the methods of

the American Society of echocardiogram.16

The LVEF has a normal value greater than 50%, mild between 45% - 54%, moderate 30% - 44%

or severe less than 30% and the study was based on values masculino.15, 16

The (Compare Guide Line) current classification of arterial pressure determines the stage of the

condition the patient's blood pressure and the values used in this study were the level of blood

pressure (mmHg) Category Systolic Diastolic Normal <120 and <80. Pre-hypertension 120-139

or 80-89. Hypertension Stage 1: 140-159 or 90-99. Stage 2: 160 or 100.19

Instruments and data collection

The data were obtained with echocardiography study on the M-mode of the ultrasound

equipment Esaote Biosound model. The image of innovation; System type: MyLab 30CV; Serial

number: 01812. Medical records of patients who had attended the clinic during the months

indicated were also evaluated.

Statistical procedures

The following data were analyzed. In medical records: blood pressure, age, sex. The results of

cardiac ultrasound studies in patients request of echocardiography.

Ethical Aspects

All the recollected information of the study was authorized by the patients with an informed

consent and by the administrative department of the clinic.

RESULTS

Of all patients studied (n=218), 58.71% (n=128) had high blood pressure( ), among hypertensive

patients found, 41.4% (n=53) demonstrated LVH, as shown in Figure 1.

Among patients of 70 years or older 2.29% (n = 50) it was found 94% (n = 47) with hypertension

and among hypertensive patients founded it was recorded 46.80% (n = 22) of LVH. Among

female patients of 70 years or older 15.59% (n = 34), all of them had high blood pressure 100%

(n = 34) and among the hypertensive 47.05% (n = 16) demonstrated LVH.

The males aged 70 and older 7.33% (n = 16), 81.25% (n = 13) presented HTN and among those

with HTN, 46.15% (n = 6) demonstrated LVH. The number of patients can be seeing, based on

the total universe in Graphic 1.

Among patients of 69 years or less 77.06% (n = 168), it was found 48.21% (n = 81) of HTN and

among those patients hypertensive, 56.79% (n = 46) demonstrated LVH. Among female patients

of 69 years or less it was presented 26.78% (n = 45) of HTN and among hypertensive female

patients 69 years or less it was recorded 40% (n = 18) of LVH, Graphic 2.

Of men of 69 years or less it was presented 21.42% (n = 36) of HTN and among hypertensive

men of 69 years or less there was 77.77% (n = 28) of LVH, as shown in Graphic 2.

The patients with HTN presented LVEF of normal 97.6%, mild 1.6%, moderate 0.0% and severe

0.8% in the period, based on male values, as shown in Graphic 3.

DISCUSSION

The prevalence of LVH in patients with HTN found in this study (41.4%) is higher compared

with the results present in the Spanish journal of cardiology, showed 20.3%, 20

but the prevalence

of LVH presented in the Spanish journal of cardiology was taken by the electrocardiogram, as

compared with the results of Journal of the American Heart Association, 14.6% findings of LVH

in hypertensive patients, 21

the results of this study are still prominent.

In the town of Silver Spring, MD and D.C. is the prevalence of LVH in hypertensive patients and

is consistent with the values of LVH according the work of Devereux, the same technique used

in M-mode ultrasound with values between 12-30% of LVH or up to 60% when compared

hypertensive population reference centers in the treatment of HTA.22

Among patients 70 years or older found 94% with HTN and among those 69 years or less the

value of HTN decreased nearly doubled to 48.21%. This tells us that the percentage of HTN

patients of 70 years or more it becomes almost double, making it equivalent to the Framingham

Heart Study revealed that the older the patient, the greater the risk of hypertensive patients

presenting HVI.4

Among patients 69 years or so shows that LVH is high compared to the number of hypertensive

patients in the group of greater than or equal to 70 years, what makes us think (changing), and

that as hypertension is a silent disease, 1

lot patients do not know the severity of the disease,

leaving a shortfall in the treatment of hypertension in the productive age male and female

professional.

The main limitation of this study is their cross-cutting, limited observational estimates of the

prevalence of LVH in hypertensive patients, whereas pre-treatment variations as BP in

hypertensive patients. The variability of myocardial damage increase or decrease is not set and

the LVEF was not considered in relation to medication use of patients studied.

The increased variability of blood pressure in elderly patients may be present for the decline in

baroreceptor reflex function associated with increased stiffness and decreased elasticity caused

by old age and HTN.

The study shows the prevalence of LVH present in patients with HTN and surprised with the

absence of LVH in all hypertensive patients 70 years or more (n = 3), confirming other studies

on the high prevalence of LVH in patients greater than or equal to 70 years, 3 and the relationship

with the existence of the HTA.5, 6

Among all hypertensive patients studied, LVEF is expressed normally, which tells us that the

relation of blood pressure is directly related to the contractility cardiaca.8

We conclude that people who suffer from HTN and LVH caused by their lack of control,

especially the group of patients of 69 years does not know their status and have access to

diagnostic tools for proper monitoring and medical treatment because no satisfactory

socioeconomic factors and education level are not limiting so that patients could get more

information about the disease they suffer.

It is recommended that local health professionals who insist on educating the population and put

emphasis on home monitoring of blood pressure, as in patients 69 years or less have high blood

pressure and 56.79% (n = 46) of LVH among this hypertensive patients, these data are

worrisome because if compared between patients over 70 with younger patients, the prevalence

of LVH is more prominent among younger hypertensive patients.

It would help further studies for deeper correlation and pathogenesis of LVH associated with

blood pressure and LVEF to better prevent the consequence of the chronic development of

hypertensive cardiomyopathy, which is to be as devastating as the advanced stage other

complications of hypertension.

CONCLUSION

Among patients with HTN 58.71% (n = 128) there is a prevalence of LVH of 41.4% (n = 53).

The prevalence of LVH found in patients with HTN for men and women aged 70 or older

prevailed in female patients (47.05%) compared to male patients (46.15%).

Among patients of 70 years or older there are 94% with HTN and among those 69 years or less

the value of HTN goes under nearly the double to 48.21%.

The LVEF among hypertensive patient compared with non-hypertensive, there is a

predominance of abnormal LVEF among patients with hypertension compared to non-

hypertensive studied.

Figure 1: Comparison with hypertension and left ventricular hypertrophy.

Graphic 1: Patients presenting more risc of LVH, blue color: HTN, red color: LVH and HTN,

left axis: Number of patients.

0

5

10

15

20

25

30

35

40

45

50

Male Female Total

13

34

47

6

16

22

Patients of 70 years or more

Graphic 2: Patients presenting less risc of LVH, blue color: HTN, red color: LVH and HTN, left

axis: Number of patients.

Graphic 3: Percentual of LVEF presented in HTN patients (red color) and non-HTN patients

(blue color) based on male values, left axis: Patients percentage (100%).

0

10

20

30

40

50

60

70

80

90

Male Female Total

36

45

81

28

18

46

Patients of 69 years or less

0

10

20

30

40

50

60

70

80

90

100

Severe Moderate mild Normal

0 0 0

100

0.8 0 1.6

97.6

Left Ventricular Ejection Fraction

ACKNOWLEDGMENTS

Francisco A. Matheus, M.D., P.C., Gonzalo Alberto Rincón, M.D. and Theodros Dagnew, M.D.,

for them professional medical education and professional support of diagnostic imaging. My

acknowledgments to the Medical Center located at 13018 Georgia Ave Silver Spring, MD 20906

with their respective secretaries offices, Lizabeth Cardon De Pazos, Sandra Patricia Cea,

Gabriela Tirado and Elizabeth Cindy Climaco.

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