Enhanced radial late systolic pressure augmentation in hypertensive patients with left ventricular hypertrophy

Background: Wave reflection augments central blood pressure (BP) in late systole, thus increasing cardiac afterload. We examined the relationship between late systolic pressure augmentation in the peripheral radial artery pulse wave and the existence of left ventricular hypertrophy (LVH) in hypertension. Methods: Brachial BP, radial augmentation index (AI_r), and carotid-femoral pulse wave velocity (PWV_cf) were determined in 77 untreated hypertensive patients aged 56 ± 10 years. Cardiac structure and function were assessed by ultrasound, and LVH was defined based on the LV mass index (LVMI). Using multivariate analysis, patient characteristics were compared between those with (+) and without (-) LVH. Results: The LVMI was correlated independently and positively with AI_r (β = 0.33, P = .004) and the brachial mean arterial pressure (MAP; β = 0.25, P = .03). The ratio of early to atrial peak velocities (E/A ratio) of the diastolic transmitral flow tended to be correlated negatively with the AI_r. The LVH (+) group had a significantly higher AI_r than the LVH (-) group [LVH (+), 97% v LVH (-), 89%, P = .003]; this difference remained significant even after adjustment for age, gender, MAP, and heart rate. The adjusted relative risk of LVH was 1.99 for each 10% AI_r increase (P = .005). In contrast, LVMI was not correlated with the PWV_cf, and the PWV_cf was not different between the LVH (+) and LVH (-) groups. Moreover, there was no significant correlation between PWV_cf and AI_r. Conclusions: These results suggest that the peripheral AI_r measurement is clinically useful in predicting LVH. Enhanced wave reflection may be related to the development of LVH in hypertensive patients.