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Left ventricular concentric remodelling defines a modified left ventricular geometry in the presence of a normal left ventricular mass; it is an early and frequent adaptation in arterial hypertension. The present study was designed to evaluate the extent of carotid structural changes in essential hypertensives with left ventricular remodelling.Two groups of hypertensive patients, who had never previously received anti-hypertensive treatment, 14 with left ventricular concentric remodelling (group I, relative wall thickness 0.48 ± 0.02) and 48 with normal left ventricular geometry (group II, relative wall thickness 0.37 + 0.04) underwent clinical and laboratory examination, echocardiography, carotid artery ultrasonography and 24 h ambulatory blood pressure monitoring (ABPM). The left ventricular dimensions and mass were obtained according to the Penn convention. The intima—media thickness (IMT) of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the bulb and the average value was used for analysis.In both groups age (group I 44 + 9 years; group II 40 + 9 years), body surface area (group I 1.85 ± 0.2 m2; group Il 1.80 +0.2 m2), duration of hypertension (group I 4.4 + 4; group II 3.8 + 3.9 years), metabolic parameters and smoking habits were similar. Both clinic and 24 h ABPM values were higher in group I (clinic 157 + 12/102 + 5; 24 h ABPM 145 ± 10/95 + 7 mmHg) than they were in group II (clinic 146 ± 11/97 ±5; 24 h ABPM=134 + 10/87 ± 8 mmHg, P<0.01). The left ventricular mass index (LVMI) and IMT were found to be slightly but significantly greater in group I than they were in group II (LVMI 106 + 7 versus 98 ± 12g/m2, P<0.05; IMT 0.68 ± 0.13 versus 0.61 ± 0.10 mm, P<0.05). A significant correlation was found between LVMI and common carotid IMT in the whole group of hypertensive patients (r=0.43, P<0.01).Our results indicate that left ventricular concentric remodelling does not represent the only early cardiovascular change in arterial hypertension but rather is associated often with carotid intima—media thickening.