ASYMMETRIC LEFT-VENTRICULAR REMODELING DUE TO ISOLATED SEPTAL THICKENING IN PATIENTS WITH SYSTEMIC HYPERTENSION AND NORMAL LEFT-VENTRICULAR MASSES

Early identification of left ventricular (LV) structural changes may have an impact on the outlook of patients with essential hypertension. Of 669 untreated hypertensive subjects, 496 (74%) with normal LV mass at echocardiography (<125 g/m(2)) were grouped according to normal LV geometry (n = 303; 61%), asymmetric LV remodeling due to isolated septal thickening (n = 111; 22%), asymmetric LV remodeling due to isolated posterior wall thickening (n = 5; 1%), or concentric LV remodelling due to septal and posterior wall thickening (n = 77; 16%). Remodeling was defined as twice the thickness of septum or posterior wall divided by the internal diameter at end diastole >0.45. Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring was performed in all subjects. Compared with subjects with normal LV geometry, those with asymmetric LV remodeling due to isolated septal thickening showed increased clinic BP (158/100 vs 153/97 mm Hg, both p <0.05), mean daytime ambulatory BP (144/95 vs 138/90 mm Hg, both p <0.01), mean nighttime ambulatory BP (128/80 vs 122/76 mm Hg, both p <0.01), LV mass (99 vs 89 g/m(2), p <0.001), total peripheral resistance (1,881 vs 1,562 dynes s cm(-5), p <0.01) and known duration of hypertension (5.5 vs 3.6 years, p <0.01) and decreased stroke index (39 vs 47 ml/m(2), p <0.01). Compared with subjects with isolated septal thickening, those with concentric LV remodeling had a longer duration of hypertension (8.3 years, p <0.05), increased peripheral resistance (2,216 dynes s cm(-5), p <0.01), decreased stroke index (32.6 ml/m(2), p <0.01), and a slightly increased nighttime systolic: BP, but no differences in clinic BP, daytime BP and LV mass. In summary, 22% of untreated hypertensive subjects with normal LV mass have a distinct geometric pattern of asymmetric LV remodeling due to isolated relative increase in the septal thickness. This early and frequent structural abnormality of the left ventricle is accompanied by clinical characteristics potentially associated with increased cardiovascular risk.