Determinant of cardiac hypertrophy in elderly hypertension

In order to define the factors responsible for cardiac hypertrophy in elderly hypertension, blood pressures and non-hemodynamic humoral parameters were correlated with echocardiographic left ventricular mass (LVM) in 30 elderly hypertensive patients and 30 age-matched normotensive subjects with a mean age of 65 years. Arterial blood pressures were obtained either at the clinic, after supine rest, during maximal exercise test, or with a 24 hour ambulatory monitoring device at 10 minute intervals. Interventricular septum and posterior wall thickness, but not end-diastolic diameter, were significantly increased in the hypertensives than in the normotensives. LVM was significantly correlated with all of te blood pressure parameters, having the strongest association with the mean of ambulatory systolic blood pressures (r = 0.65, p less than 0.001). On the other hand, plasma norepinephrine (r = 0.09), plasma renin activity (r = -0.14), and atrial natriuretic factor (r = -0.08), though known to influence cardiac adaptation to hypertrophy in young or middle aged hypertensives, were not correlated wit LVM. These results suggest that the heart in elderly hypertension is characterized by concentric hypertrophy, the only significant determinant of which appears to be a hemodynamic factor. Unlike younger patients, sympathetic nervous and renin-angiotensin systems may not play an important role in the development of cardiac hypertrophy in the elderly.