Hypertension Vascular hypertrophy is an early finding in essential hypertension and is related to arterial pressure waveform contour Frank D. Tice, MD, James W. Peterson, MD, David A. Orsinelli, MD, Philip F. Binkley, MD, Robert J. Cody, MD, Robert Guthrie, MD, and Anthony C. Pearson, MD Columbus, Ohio The effects of hypertension on the arterial vasculature were examined in a study group of 20 patients with newly diagnosed essential hypertension, 18 patients with chronic essential hypertension, and 32 control subjects with normal blood pressure. Left ventricular mass was determined echocardiographically. Carotid artery intimal-medial thick- ness was measured by means of B-mode ultrasound imag, ing, and carotid arterial waveforms were obtained by appla- nation tonometry. Compared with that in control subjects, carotid intimal-medial thickness was increased in patients with chronic hypertension (0.74 ± 0.17 mm vs 0.61 ± 0.15 mm in control subjects; p < 0.01) and in patients with newly diagnosed hypertension (0.66 ± 0.12 mm vs 0.61 ± 0.15 mm in control subjects; p < 0.05). Left ventricular mass was also higher in patients with chronic hypertension than in control subjects but was very similar between control subjects and those with newly diagnosed hypertension. Both the group with early hypertension and the group with chronic hyper- tension had an increased incidence of early waveform reflection evident on carotid arterial waveform examination. By multiple regression analysis, independent predictors of increased carotid intimal-medial thickness were age, sys- tolic arterial pressure, and Murgo class of arterial waveform. Conduit arterial wall thickening precedes left ventricular re- modeling in essential hypertension and is significantly related to the degree of pressure elevation and the arterial waveform contour. (Am Heart J 1996;132:621-7.) Arterial hypertension represents an important stim- ulus for myocardial hypertrophy, with the resultant From the Department of Internal Medicine, Division of Cardiology, The Ohio State University. Dr. Petersou was supported in part by a Postdoctoral Research Fellowship from the American Heart Association, Ohio Affiliate. Received for publication Dec. 13, 1995; accepted Jan. 22, 1996. Reprint requests: Anthony C. Pearson, MD, The Ohio State University Hospitals, 6th Floor Means Hall, 1654 Upham Dr., Columbus, OH 43210~ 1228. Copyright © 1996 by Mosby-Year Book, Inc. 0002-8703/96/$5.00 + 0 411/73670 increase in left ventricular mass serving as an adap- tive mechanism to normalize wall stress. 1 An ad- verse consequence of this increase in myocardial mass is a marked amplification of the risk for stroke and coronary heart disease. 2 It also has been sug- gested that increased left ventricular mass is associ- ated with early reflection of the central arterial pressure waveform and increased carotid wall thick- ness. a,4 Whether these abnormalities develop in parallel or separately during arterial hypertension is not clear. Furthermore, the relation of arterial pres- sure waveform to structural alterations in the vas- culature and myocardium has not been fully investi- gated in the setting of arterial hypertension. There- fore, the current study was designed to explore the temporal development of structural and functional changes in the vasculature and the left ventricle in patients with arterial hypertension and to examine the relation of arterial pressure waveform to the de- velopment of these changes. METHODS Patient population. The study population for this inves- tigation consisted of 20 patients with newly diagnosed and untreated hypertension; 18 patients with chronic hyper- tension (mean duration 13 _+ 10 years) for which they had received medical treatment; and 32 control patients, with normal blood pressure. Hypertension was defined as a sys- tolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg on each ofthree measurements taken at l-week intervals. Patients with clinical or laboratory evidence of secondary causes of hypertension were excluded. Adminis- tration of antihypertensive medications was discontinued for 2 weeks before the study. No patient had evidence of cardiac, renal, or cerebrovaszular disease. All patients had normal left ventricular function by two-dimensional echo- cardiography. The presence of significant valvular heart disease was excluded by Doppler echocardiography. 621