Impact of hypertension on left ventricular hypertrophy regression and exercise capacity in patients operated for aortic valve stenosis

Figures & data

Table I.  Baseline characteristics of the study population.

	All patients (n = 78)	Hypertensive (n = 43)	Normotensive (n = 35)
Age (years)	70±10	72±6*	67±13
Women (%)	51	51	51
Body surface area (m^2)	1.79±0.19	1.77±0.17	1.81±0.22
Prosthetic valve type
Medtronic Hall	33	15	18
Biocor	8	4	4
Carpentier Edwards S.A.V.	14	8	6
Freestyle	23	16	7
Prosthetic valve diameter† (cm)	2.39±0.20	2.36±0.21	2.41±0.19
Aortic regurgitation grade 1	32	16	16
Coronary artery by-pass	24	15	9
Systolic blood pressure (mm Hg)	132±22	138±24**	125±18
Diastolic blood pressure (mm Hg)	72±10	73±10	70±9
Heart rate (beats/min)	83±18	80±18	86±16

†Manufacturer-declared

*p < 0.05 between the hypertensive and the normotensive group

**p < 0.01 between the hypertensive and the normotensive group.

Figure 1.  Change in systolic and diastolic blood pressure during follow-up.

Figure 2.  Time course of LVMI regression post AVR.

Table II.  Echocardiographic characteristics of hypertensive versus normotensive patients

	Baseline		Early		Late
	HT	NT	HT	NT	HT	NT
Left atrium diameter (cm)	4.03±0.68	4.02±0.71	3.99±0.69	3.81±0.75	4.01±0.61	3.90±0.73
LV internal diameter in diastole (cm)	4.50±0.79	4.43±0.89	4.54±0.69	4.63±0.68	4.82±0.62	4.70±0.77
Interventricular septum thickness in diastole (cm)	1.75±0.37	1.70±0.44	1.39±0.32	1.40±0.38	1.25±0.35	1.23±0.32
Posterior wall thickness in diastole (cm)	1.34±0.26	1.39±0.31	1.19±0.20	1.15±0.23	1.09±0.18	1.15±0.23
LV internal diameter in systole (cm)	3.32±0.84	3.19±0.78	3.33±0.71	3.28±0.67	3.36±0.66	3.25±0.68
LV ejection fraction	0.59±0.15	0.62±0.13	0.60±0.15	0.63±0.13	0.64±0.13	0.66±0.10
LVMI (g/m^2)	167±59	162±60	128±43	128±33	123±37	119±40
Peak transprosthetic velocity (m/s)	2.38±0.45	2.27±0.42	2.09±0.43	2.18±0.41	2.23±0.54	2.25±0.49
Mean transprosthetic gradient (mm Hg)	13±5	13±4	10±4	12±4	10±4	12±4
Doppler effective valve area (cm^2/m^2)	0.88±0.30	0.96±0.31	1.00±0.31	1.11±0.50	1.07±0.39	1.09±0.36
Isovolumic relaxation time (ms)	96±22*	83±23	109±26	101±28	106±33**	87±28
Peak E (m/s)	0.92±0.28**	0.70±0.16	0.75±0.26	0.69±0.25	0.82±31	0.73±0.23
Peak A (m/s)	0.93±0.33**	0.70±0.23	0.99±0.35**	0.75±0.23	0.96±0.30*	0.82±0.26

*p < 0.05 between the hypertensive and the normotensive group.

**p < 0.01 between the hypertensive and the normotensive group.

Table III.  Predictors of LV hypertrophy regression during 18-month follow-up. Multiple regression analysis (multiple R²=0.68, p < 0.05).

Variable	Beta	T	P
LVMI at baseline (g/m^2)	0.831	11.593	0.000
Age (years)	−0.172	−2.181	0.033
History of hypertension	−0.009	−0.121	0.904
Female gender	0.136	1.860	0.067
Freestyle prosthetic valve	0.190	2.450	0.017
Baseline ejection fraction	0.054	0.752	0.455
Prosthetic valve Doppler effective area	−0.100	−1.337	0.186

LVMI = left ventricular mass index.

Table IV.  Exercise capacity in hypertensive and normotensive patients.

	Early		Late
	HT	NT	HT	NT
Peak oxygen uptake (ml/kg/min)	22.2±5.4	24.3±8.4	21.1±5.1**	27.1±9.5
Respiratory quotient	0.99±0.11	1.00±0.08	0.97±0.16	1.00±0.15
Exercise time (min)	11.4±3.7	13.5±3.5	11.5±3.5**	14.3±3.4
Exercise distance (m)	523±291	686±287	550±217*	748±278
Metabolic equivalents	5.78±2.05	6.64±2.65	5.88±1.84*	7.21±2.42
Peak systolic blood pressure (mm Hg)	205±24*	189±30	206±37*	187±21

*p < 0.05 between the hypertensive and the normotensive group.

**p < 0.01 between the hypertensive and the normotensive group.

Table V.  Predictors of improvement in exercise capacity in multiple regression analysis (multiple R²=0.37, p < 0.05).

Variable	Beta	T	p
Early peak 02 uptake	−0.458	−3.139	0.003
Age (years)	−0.353	−2.406	0.021
Male gender	0.265	2.027	0.050
History of hypertension	−0.306	−2.266	0.029
Freestyle prosthetic valve	0.021	0.140	0.889