Relation of concentric left ventricular hypertrophy and extracardiac target organ damage to supranormal left ventricular performance in established essential hypertension

Increased cardiac performance has been documented in patients with early systemic hypertension, but its prevalence and determinants in patients with uncomplicated sustained essential hypertension have not been characterized. Radionuclide cineangiography in 116 patients with uncomplicated essential hypertension showed that 12 of 116 (10%) had supranormal resting left ventricular (LV) ejection fraction (>70%, above the highest value in normal subjects), while 104 patients had a normal resting ejection fraction (45 to 70%). Patients with a high resting ejection fraction had higher systolic and diastolic blood pressure compared with patients with normal resting ejection fraction (182 mm Hg vs 169, p < 0.01, and 110 vs 103, p < 0.05, respectively), markedly greater echocardiographic LV mass (136 vs 94 g/m2, p < 0.01), smaller ventricular dimensions in systole (2.5 vs 3.1, p < 0.01) and diastole (4.4 vs 4.9, p < 0.05), and higher relative wall thickness (0.61 ± 0.20 vs 0.39 ± 0.98, p < 0.001). Patients with supranormal resting ventricular performance had lower end-systolic wall stress than normal volunteers or patients with normal resting LV function (48 vs 64 vs 74 × 103 dynes/cm2, respectively). Patients with an elevated LV ejection fraction also had significantly more abnormal funduscopic examinations and greater proteinuria. Thus, a subset of essential hypertensive patients with moderately to severely elevated blood pressure developed marked concentric LV hypertrophy associated with subnormal end-systolic stress and supranormal LV performance. These patients manifested greater peripheral target organ damage than patients with lower ejection fraction but lesser hypertrophy, suggesting that the severity of their hypertensive cardiovascular disease is more accurately reflected by indexes of cardiac hypertrophy than of LV performance.