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.

echocardiography, hypertension, pulmonary hypertension, pulmonary vascular resistance, right ventricle,
Journal of Hypertension

Vriz, O., Pirisi, M., Bossone, E., ElMula, F., Palatini, P., & Naeije, R. (2020). Right ventricular-pulmonary arterial uncoupling in mild-to-moderate systemic hypertension. Journal of Hypertension, 38(2), 274–281. doi:10.1097/hjh.0000000000002238