Ascending aortic dilatation, arterial stiffness and cardiac organ damage in essential hypertension

Objectives: The objectives of this study were to evaluate the prevalence of dilatation of proximal ascending aorta (pAA) in essential hypertensive patients and the association between pAA dilatation, arterial stiffness and left ventricular hypertrophy. Background: Few data are available regarding patients with pAA dilatation in arterial hypertension. It is not known whether pAA dilatation may be related to increased left ventricular mass and what the relation with central hemodynamics and arterial stiffness would be. Methods: A total of 345 untreated and treated essential hypertensive patients (mean age, 54.3 +/- 11 years) were considered for this analysis. We measured pulsatile hemodynamic parameters directly using tonometry, and the proximal aortic diameters through ultrasound imaging (echocardiography). Results: Prevalence of pAA dilatation was 17%. Peripheral hemodynamic parameters were similar in patients with and without ascending aorta dilatation. We observed a slight increase of central systolic (129.81 +/- 15.4 vs. 125.02 +/- 14.7 mmHg; P = 0.02) and pulse pressure (45.02 +/- 10.4 vs. 42 +/- 9.54 mmHg; P = 0.02) in patients with pAA dilatation. Pulse wave velocity (9.26 +/- 2.33 vs. 7.70 +/- 1.69 m/s; P < 0.0001), as well as the augmentation index (25.86 +/- 10.2 vs. 19.41 +/- 9.52%; P < 0.0001), was significantly greater in patients with pAA dilatation. Finally, left ventricular hypertrophy was thrice as frequent (32.8 vs. 13.4%; P < 0.0001) compared to hypertensive patients without aortic dilatation. Conclusion: This study shows a high prevalence (17%) of ascending aortic dilatation in patients affected by essential hypertension, without further complications. Dilatation of the ascending aorta is associated both to an increased left ventricular mass and arterial stiffness.