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Older Women May Be at Risk for Pulmonary HTN

NATIONAL HARBOR, Md.  -  Of patients with systemic hypertension but preserved ejection fraction, those with pulmonary hypertension tended to be older and female, a retrospective study found.

Nearly three-quarters (72%) of the patients with pulmonary hypertension (PH) were women compared with 49% of those without PH, reported Monica Mukherjee, MD, from George Washington University in Washington, D.C., and colleagues.

Moreover, the mean age of those with PH was 77, compared with 64 in those without PH, according to Mukherjee's presentation at the American Society of Echocardiography meeting.

The patients with PH also tended to have left ventricular (LV) hypertrophy, as well as elevated pulmonary vascular resistance, which "implies potentially irreversible changes to the pulmonary vasculature," Mukherjee said.

"These patients with pulmonary hypertension coexisting with systemic hypertension should be identified earlier so that aggressive management can be started and outcomes improved," she told MedPage Today.

In fact, Mukherjee and colleagues are now being more aggressive with the use of calcium channel blockers in such patients in their clinic. Anecdotally, she said they have noticed a reduction in the rates of hospitalization and readmission for hypertension and diastolic heart failure.

She was quick to point out, however, that the roles and implications for aggressive management with calcium channel blockers have not yet been delineated.

A future line of inquiry will look at how phosphodiesterase inhibitors may impact pulmonary vascular resistance. In addition, the investigators are testing echo speckle tracking in these patients to determine if "something is happening within the myocardium that can explain the changes to the pulmonary vasculature," Mukherjee said.

She explained that there might be different strain rates (a measure of flexibility) that occur in the microvasculature before clinicians see changes in gross symptoms. "That may be one way for earlier identification of these patients," she said.

For this study, researchers reviewed the echocardiograms and hospital records of hypertensive patients with LV hypertrophy and preserved ejection fraction from 2009 to 2011. They identified 36 with PH and 138 without PH.

Those with PH tended to be older (P=0.01), female, African American, have a lower estimated glomerular filtration rate (P=0.002), and higher pro-BNP levels (P=0.002). Patients with PH also had larger left atrial appendages and significantly increased diastolic dysfunction indices, as evidenced by a greater E/e' septal (P=0.005) and E/e' lateral (P<0.001), Mukherjee said.

"These are patients that do not have primary pulmonary disease, yet they have changes in the pulmonary vasculature that correspond with diastolic indices," she said.

Primary source: American Society of Echocardiography            

Source reference:       Mehta NK, et al "Pulmonary hypertension in hypertensive patients: Association with diastolic dysfunction and increased pulmonary vascular resistance" ASE 2012; Abstract P1-14.

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