Non-invasive signs of cardiac involvement in essential hypertension

The relationship between various non-invasive signs of hypertensivecardiac involvement and blood pressure (BP) was studied in 120middle-aged men recruited from a BP-screening of a random populationsample. The men, representing a wide range of BP, were dividedinto four BP groups (normotensive, and borderline, mild andmoderate-severe hypertension), and were investigated by conventionalelectrocardiography (ECG), chest X-ray, echocardiography, apexcardiography/phonocardiographyand corrected orthogonal ECG. In the hypertensive groups a lower proportion of subjects withsigns of cardiac involvement were identified by conventionalECG and chest X-ray than by the other methods. A significantassociation between the prevalence of pathological findingsand level of blood pressure (P < 0.05–0.01) was foundfor conventional and corrected orthogonal ECG and apexcardiography/phonocardiography.With echocardiography, concomitant increased thickness (>12 mm) of both the interventricular septum and left ventricularposterior wall, but not of one structure alone, was significantlyassociated with BP (P < 0.05). In borderline subjects, pathological findings were surprisinglycommon. However, many of these subjects had single abnormalities,whereas those with higher BP had an increasing degree of multiplepathological findings. We conclude that in many hypertensives there are signs of cardiacinvolvement that can be revealed by means of sensitive non-invasivemethods. Single signs can be revealed in mild hypertension butthe number and severity of the different abnormalities increases(dramatically) with increasing BP. It is probable that thesevarious types of cardiac involvement carry prognostic informationthat could help in treatment decisions.