Early Left Ventricular Mechanics Abnormalities in Prehypertension: A Two-Dimensional Strain Echocardiography Study

Background Prehypertension predicts established hypertension. In this study, the aim was to analyze left ventricular (LV) mechanics in borderline prehypertensive (pre-HT) and hypertensive (HT) subjects through two-dimensional (2D)-strain echocardiography and then evaluate possible relations between cardiac parameters and insulin metabolism (homeostasis model assessment of insulin resistance (HOMAIR)). Methods Seventy-four consecutive newly diagnosed, untreated HT were divided, on the basis of their office blood pressure (BP) measurements, confirmed by ambulatory BP monitoring (ABPM), in 41 borderline pre-HT (ABPM: 122.5 ± 6.7/76.2 ± 5.2mmHg) and 33 never-treated mild HT (ABPM: 138.3 ± 7.3/87.6 ± 7.1mmHg). Thirty-three healthy normotensive (NT) controls (ABPM: 114.8 ± 6.3/73.1 ± 6.1mmHg) (P < 0.0001) were also studied (NT). All subjects performed 2D color Doppler and pulsed-wave tissue Doppler imaging (PW-TDI). Results Left ventricular mass (LVM) was significantly higher in pre-HT (39.2 ± 8.7g/m2.7) and in HT (43.6 ± 8.5g/m2.7) compared with NT (30.9 ± 7.4g/m2.7) (P < 0.0001). A mild LV diastolic dysfunction was found both with Doppler mitral flow velocity and PW-TDI at mitral annulus level analysis. Longitudinal 2D strain in pre-HT (−18.9% ± 3.4) and in HT (−18.0% ± 3.3) was significantly lower than in NT (−23.9% ± 3.0) (P < 0.002). These LV abnormalities were associated with systolic ABPM, LVM, and HOMAIR. Conclusions Early abnormalities of LV longitudinal systolic deformation were found both in pre-HT and HT, together with a mild LV diastolic dysfunction. In both groups this early cardiac systolic and diastolic dysfunction is associated to insulin resistance, systolic pressure load, and cardiac remodeling.