Right ventricular-pulmonary arterial uncoupling in mild-to-moderate systemic hypertension

Background: Mild-to-moderate hypertension with preserved left ventricular (LV) function may be associated with right ventricular (RV) dysfunction and increased pulmonary vascular resistance (PVR). Methods: The present study explored the adequacy of RV–pulmonary arterial (PA) coupling in 211 never-treated hypertensive patients (mean blood pressure, BP 112 12 mmHg) and 246 controls (BP 93 12 mmHg). They underwent a comprehensive transthoracic Doppler echocardiography, and RV–PA coupling was estimated by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio (TAPSE/ PASP). Results: Compared with the controls, hypertensive patients had increased LV wall thickness and decreased trans-mitral E/A with only slight but significant increase in transmitral Doppler E wave to tissue Doppler mitral annulus e0 wave ratio (6.3 1.9 vs. 5.8 1. 5, P < 0.05). RV dimensions and indices of either systolic or diastolic function were not different. PASP was increased in the hypertensive patients (25 7 vs. 21 7 mmHg, P < 0.001), as was PVR estimated from the tricuspid regurgitation velocity to right ventricular outflow tract velocity ratio (1.7 0.4 vs. 1.5 0.5 Wood units, P < 0.001). The TAPSE/ PASP ratio was decreased (1.08 0.35 vs. 1.43 0.67 mm/ mmHg, P < 0.001). This difference was mainly driven by male hypertensive patients. At multivariable analysis, the only independent predictors of decreased TAPSE/PASP were age and blood pressure. Conclusion: The TAPSE/PASP is markedly decreased in hypertension without heart failure, chiefly in men, with only slight increases in estimates of LV filling pressure or PVR, suggesting RV–PA uncoupling.

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