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Objective To study the changes of heart structure and left ventricular diastolic function in patients with essential hypertension.Methods One hundred and fifty one consecutive patients with primary hypertension were selected as hypertensive group, which was then divided into three subgroups:hypertensive group 1(the duration of hypertension≤5years, n:72), hypertensive group 2(5years<the duration of hypertension≤10years, n:38), and hypertensive group 3(the duration of hypertension≥10years, n:41). Fifty four age and sex-matched healthy people were selected as the controls. Echocardiograms were performed by use of the methods recommended by American Society of Echocardiography and European Association of Echocardiography in 2005 and 2009. Plasma N-terminal B-type brain natriuretic peptide(NT-proBNP), lipids, glucose, urea nitrogen, creatinine and other relevant laboratory indexes were tested.Results (1) Compared with the controls interventricular septal thickness(IVSTd), posterior wall thickness(PWTd), relative wall thickness(RWT), left ventricular mass(LVM) and LVM index(LVMi), left atrial dimension(LAD), left atrial volume (LAV)of hypertensive group were singnificantly increased. IVSTd, PWTd, RWT, LVM, LVMi were increased group by group in those subgroups(P＜0.05-＜0.01). LAD, LAV, LAV index(LAVi) in hypertensive subgroup 1 have no difference with controls, but increased in hypertensive subgroup 2 and 3(P<0.05-<0.01). Left ventricular end-diastolic volume index(LVEDVi) of hypertensive subgroup1 was less than that of controls, which had no difference with hypertensive subgroup 2 but increased in hypertensive subgroup 3 (P＜0.05). (2) IVSTd, PWTd, RWT, LVM, LVMi were positively correlated with age, weight, the duration of hypertension(P<0.05-<0.01).LAV, LAVi were positively correlated with the duration of hypertension, weight, body mass index(BMI), systolic blood pressure, LVMi LVEDVi, and NT-proBNP(P<0.05-<0.01), among which, the duration of hypertension, LVEDVi, left ventricular diameter index(LVIDi) and NT-proBNP were independent predicators of LAV and LAVi (3) Compared with the controls E/A(the ratio of E wave(peak early diastolic mitral inflow velocity) with A wave (peak late diastolic mitral inflow velocity)), early velocities of lateral(E’L) and septal(E’s) mitral annulus, E’L/A’L(the ratio of E’L with A’L(late velocities of lateral) mitral annulus), E’s/A’s(the ratio of E’s with A’s(late velocities of septal) mitral annulus) were singnificantly decreased(P<0.05-<.01). A wave, A wave duration(durA), deceleration time(DT) of E wave, isovolumic relaxation time(IVRT), E/E’s, M-E/E’(average of E/E’L ratio and E/E’s ratio) were singnificantly increased(P<0.05-<0.01). E’L, E’s were decreased successively in hypertensive subgroup 1,2 and 3(P<0.05-<0.01).E/E’s, M-E/E’, E/E’L in hypertensive subgroup 3 were greater than those in hypertensive subgroup 1,2 and the controls (P<0.05-<0.01). NT-proBNP were negatively correlated with BMI, waist circumference, E’and E’/A’(P<0.05-<0.01), but positively correlated with age, the duration of hypertension, systolic blood pressure, LADi, LAV, LAVi and E/E’(P<0.05-<0.01), among which age, waist circumference and LAVi were independent predicators of NT-proBNP. E/E’ were positively correlated with the duration of hypertension, systolic blood pressure, age, BMI, pulse pressure LAV, LAVi and NT-proBNP(P<0.05-<0.01), among which the duration of hypertension, systolic blood pressure and LAVi were independent predicators of E/E’.Conclusion. 1.Patiens with essential hypertension showed left ventricular concentric remodeling/hypertrophy which existed even in the early stage of the desease. With the progress of the desease, the changes were more obvious. When the duration of hypertension approximately over 5-10years, left atrium was affected. Age, obesity, the duration of hypertension, systolic blood pressure were well related with left ventricular structure changes, but left atrial size was mainly influenced by the duration of hypertension, NT-proBNP, left ventricular end-diastolic volume index.2. There were left ventricular diastolic dysfunction in hypertensives, which may occurred in the early stage of the desease, but the definite and marked changes were appeared when the duration of hypertension was over 5-10years. Left ventricular diastolic dysfunction were related with the duration of hypertension, systolic blood pressure and left atrial size.3. Among the many parameters reflecting diastolic function in patients with hypertension, only E/E’, LAV, LAVi were better ones, which were well related with NT-proBNP.4. Left ventricular systolic function were nomal in hypertensives(left ventricular ejection fraction was not different with the controls).
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