The Relation Of Cardiac Target Organ Damage With Cardiac Autonomic Dysfunction In Hypertensive Patients: From Korean Women'S Chest Pain Registry (Korose)

Objective: Altered autonomic function is associated with development and prognosis of hypertension. But the relation between the presence of target organ damage (TOD) by hypertension and cardiovascular autonomic neuropathy (CAN) has not been evaluated. In present study, we investigated the relation between the pattern of LV geometrical changes and CAN in hypertensive patients. Design and Method: 99 hypertensive patients (M/F = 38/118, mean age = 57.4 ± 10.2 years) who had neither diabetes nor significant coronary artery stenosis and normal subject (n = 57) were included. LV geometry was classified as normal, concentric remodeling, concentric hypertrophy and eccentric hypertrophy. CAN was assessed by HR recovery (HRR: Maximal HR during exercise - HR at 3minute after exercise termination) and BP response (SBPR: systolic BP at 3minute after exercise termination/maximal systolic BP during exercise). Results: The mean age was higher in hypertensive patients (59.3 ± 9.3 vs 55.1 ± 10.4, P = 0.006) but the other clinical characteristics were similar between two groups. HRR was lower and SBPR was higher in hypertensive patients (60.8 ± 13.6 vs 65.5 ± 13.4, P = 0.048 and 0.82 ± 0.10 vs 0.79 ± 0.09, P = 0.037). When the hypertensive patients were divided according to their LV geometry, the lower HRR and higher SBPR were not observed in hypertensive patients with normal LV geometry. As the cardiac TOD progressed from concentric remodeling to eccentric hypertrophy, the cardiac autonomic dysfunction progressively worsened (Table 1). And these associations remained with statistical significance, after adjusting age, sex, smoking, dyslipidemia and obesity, by multivariate regression analysis (HRR-OR: 1.83, P = 0.034, and BPR-OR: 1.59, P = 0.006, respectively) Conclusions: Cardiac Autonomic function was preserved in patients with hypertension who did not have cardiac TOD. But as the cardiac TOD progressed, cardiac autonomic function deteriorated concurrently. These findings suggest that the degree of diminished cardiac autonomic function might be a surrogate marker for the severity of TOD in hypertension