The impact of high-normal blood pressure on left ventricular mechanics: a three-dimensional and speckle tracking echocardiography study

To assess the presence of subclinical left ventricular myocardial dysfunction in subjects with high-normal blood pressure (BP) and untreated arterial hypertension, using three-dimensional (3D) echocardiography strain analysis. This cross-sectional study included 49 subjects with optimal BP, 50 subjects with high-normal BP, and 50 newly diagnosed untreated hypertensive patients matched by gender and age. All the subjects underwent 24 h blood pressure monitoring and complete two-dimensional and 3D echocardiography examination. The enrolled subjects were grouped according to 24 h systolic BP values, dividing the subjects with optimal BP from those with high-normal BP and the hypertensive patients (cut-off values were 120 and 130 mmHg, respectively). 3D global longitudinal strain was significantly lower in the high-normal BP group and the hypertensive patients, in comparison with the optimal BP group (-20.5 +/- A 3.3 vs. -18.7 +/- A 2.8 vs. -17.6 +/- A 2.7 %, p < 0.001). Similar results were obtained for 3D global circumferential strain (-18.6 +/- A 3 vs. -17.1 +/- A 2.9 vs. -16 +/- A 2.5 %, p < 0.001), as well for 3D global radial strain (49.4 +/- A 9.5 vs. 44.7 +/- A 8.1 vs. 43.5 +/- A 7.8 %, p = 0.002), and global area strain (-31.2 +/- A 4.8 vs. -28.7 +/- A 4.2 vs. -27.1 +/- A 4.5 %, p < 0.001). LV twist was increased in the hypertensive patients in comparison with the high-normal and the optimal BP groups (10.1A degrees A A +/- A 2.4A degrees vs. 10.8A degrees A A +/- A 2.6A degrees vs. 13.8A degrees A A +/- A 3.1A degrees, p < 0.01), whereas untwisting rate significantly and gradually decreased from the optimal BP group, across the high-normal BP group, to the hypertensive patients (-135 +/- A 35 vs. -118 +/- A 31 vs. -102 +/- A 27A degrees/s, p < 0.001). 3D echocardiography revealed that the subjects with high-normal BP suffered subclinical impairment of LV mechanics similar as the hypertensive patients.