Impact of Central Aortic Pressures on Left Ventricular Mass Index

Aims: To measure central aortic pressures using Brachial cuff pulse volume plethysmography (PVP) and left ventricular mass index by echocardiography using standard DEVEREUX & REICHEK CUBE and BSA in hypertensive patients. To correlate central aortic and brachial cuff pressures with the left ventricular mass in hypertensive patients.

Study Design: cross-sectional, observational study.

Place and Duration of Study: From September 2018 to July 2020 at G Kuppuswamy Naidu Memorial Hospital, Coimbattore, Chennai.

Methodology: A total of 228 patients were included in the study, their written informed consent were obtained. With the help of a structured questionnaire basic demographic profile of the systemic hypertension patients such as Age, Gender, Family history of hypertension/CAD , smoking, duration of hypertension, number of hypertensive medications patient is on and other comorbid conditions, electrocardiogram, previous Echocardiogram if available were recorded. Newly detected hypertensives satisfying AHA/ACC definition and hypertensives fulfilling inclusion criteria were included. Patients who are satisfying inclusion criteria were subjected for measurement of Central aortic blood pressures, peripheral blood pressures, mean pulse wave velocity & augmentation index measured using non-invasive brachial oscillometry with a Mobil-O-Graph PWA device -ARC slover (IEM GmbH).Using Philips EPIQ 7 Cardiac ultrasound machine baseline transthoracic echocardiogram, Left ventricular mass index assessment by a linear method using DEVEREUX & REICHEK CUBE formula of patients was recorded. Data compiled and the statistical analysis done.

Results: We analysed 228 selected hypertensive subjects, and our observations were increased age (> 50 years), smoking, increased duration of hypertension (> 2 years), obesity, very high central Aortic Systolic, and Diastolic Pressure, high Mean Pulse Wave Velocity, and patients on Non (CCB + ACEI + ARB) group of hypertensive drugs were found to be an independent predictor for abnormal LVMI in hypertensive patients, which could be an early marker of myocardial dysfunction, major cardiovascular events and death. Central Aortic pressure (aortic systolic and diastolic pressure) was found to be the strongest predictor of abnormal LVMI among hypertensive patients in our study followed by Mean Pulse Wave Velocity.

Conclusion: Elevated central aortic pressures measured non-invasively by brachial cuff pulse volume plethysmography in hypertensive individuals are associated and statistically correlated with an increase in LVMI.