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At least 595 records · Page 33Linked to original sources
PubMed2000

Perspectives on isolated systolic hypertension in elderly patients.

Until the mid-20th century, clinicians' concern was directed mainly to the systolic component of blood pressure. Later, however, when systolic blood pressure was found to be elevated with advancing age and decreased compliance of the arterial wall, it began to be considered an inevitable consequence of aging. Based on this belief, physicians often concluded that only the diastolic blood pressure elevation, which reflected peripheral vascular resistance, was harmful, while systolic hypertension was innocuous. Therapeutic intervention was practiced mainly for diastolic hypertension, and research protocols were based on the levels of diastolic blood pressure alone. In the 1950s, even when life insurance companies' actuarial data revealed that systolic and diastolic blood pressure elevations were hazardous to health, few clinicians took heed. In 1962, the World Health Organization also defined hypertension as a blood pressure level of 165/95 mm Hg or higher for intervention purposes. However, until the 1991 Systolic Hypertension in the Elderly Program (SHEP) trial, many physicians were reluctant to pay credence to the need for therapy of elevated systolic blood pressure (vide infra).

Aged↗
PubMed2006

Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure.

CONTEXT: The association between systolic blood pressure (SBP) at admission, clinical characteristics, and outcomes in patients hospitalized for heart failure who have reduced or relatively preserved systolic function has not been well studied. OBJECTIVE: To evaluate the relationship between SBP at admission, clinical profile, and outcomes in patients hospitalized for acute heart failure. DESIGN, SETTING, AND PATIENTS: Cohort study using data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry and performance-improvement program for patients hospitalized with heart failure at 259 US hospitals between March 2003 and December 2004. Patients were divided into quartiles by SBP at hospital admission (<120, 120-139, 140-161, and >161 mm Hg). In-hospital outcomes were based on 48,612 patients aged 18 years or older with heart failure. Of the 41,267 patients with left ventricular function assessed, 21,149 (51%) had preserved left ventricular function. Postdischarge outcomes were based on a prespecified subgroup (n = 5791, 10% of patients) with follow-up data assessed between 60 and 90 days. MAIN OUTCOME MEASURES: In-hospital and postdischarge mortality. RESULTS: Patients with higher SBP were more likely to be female and black and to have preserved systolic function. Fifty percent of the patients had SBP higher than 140 mm Hg at admission. Patients with lower SBP at admission had higher in-hospital and postdischarge mortality rates. Higher SBP at admission was associated with lower in-hospital mortality rates: 7.2% (<120 mm Hg), 3.6% (120-139 mm Hg), 2.5% (140-161 mm Hg), and 1.7% (>161 mm Hg) (P<.001 for overall difference). Postdischarge mortality rates in the follow-up cohort by SBP at admission were 14.0%, 8.4%, 6.0%, and 5.4%, respectively (P<.001 for overall difference). CONCLUSIONS: Systolic hypertension is common in patients hospitalized for heart failure. Systolic blood pressure is an independent predictor of morbidity and mortality in patients with heart failure with either reduced or relatively preserved systolic function. Low SBP (<120 mm Hg) at hospital admission identifies patients who have a poor prognosis despite medical therapy. These findings may have important therapeutic implications because characteristics and outcomes differ greatly among patients with heart failure with varying SBP.

Acute Disease↗
PubMed2000

Effect of hemodynamic conditions on sonographic measurements of peak systolic velocity and arterial diameter in patients with peripheral arterial stenosis.

PURPOSE: We measured changes in peak systolic velocity ratio and sonogaphic vascular diameter during different hemodynamic conditions in patients with femoral or iliac artery stenosis. METHODS: In 35 patients with isolated femoral or iliac artery stenosis, prestenotic and intrastenotic peak systolic velocity and inner vascular diameter were calculated using color Doppler sonography and gray-scale sonography, respectively. The measurements were performed with the patient at rest (baseline), after leg exercise, and again after oral administration of 10 mg of the vasodilator nifedipine. RESULTS: The mean prestenotic and intrastenotic peak systolic velocity and the peak systolic velocity ratio (intrastenotic/prestenotic peak systolic velocity) were 70 +/- 31 cm/second, 360 +/- 130 cm/second, and 6.5 +/- 3.6 at baseline; 78 +/- 37 cm/second, 404 +/- 171 cm/second, and 6.6 +/- 4.2 after leg exercise; and 71 +/- 30 cm/second, 353 +/- 109 cm/second, and 5.9 +/- 3.2 after nifedipine administration. The mean prestenotic and intrastenotic diameter and percentage of diameter reduction were 5.9 +/- 3.2 mm, 2.3 +/- 1.1 mm, and 59 +/- 13% at baseline; 4.8 +/- 2.4 mm, 2.0 +/- 1.3 mm, and 62 +/- 13% after leg exercise; and 5.9 +/- 2.9 mm, 2.5 +/- 1.0 mm, and 54 +/- 14% after nifedipine administration. Only the difference in intrastenotic diameter after leg exercise was significantly different from baseline. CONCLUSIONS: The peak systolic velocity ratio in peripheral arterial stenosis seems to be relatively independent of the hemodynamic conditions and cannot be used for investigations of vasomotion of stenotic arterial segments during different hemodynamic conditions.

Administration, Oral↗
PubMed1996

Uniquely abnormal intracavitary flow during late systole and relaxation in hypertrophic obstructive cardiomyopathy with midventricular obstruction.

We describe a patient with hypertrophic cardiomyopathy who had a uniquely abnormal jet from the base to the apex during late systole and the relaxation period. This 48-year-old woman was admitted with exertional dyspnea and palpitations. Two-dimensional echocardiography revealed asymmetric septal hypertrophy and a left midventricular obstruction at the level of the papillary muscles. A high-velocity ejectional jet (peak velocity 4.8 m/s) directed toward the base during systole and an abnormal jet (peak velocity 2.2 m/s) directed toward the apex during late systole and the relaxation period were demonstrated through the midventricular obstruction site using Doppler echocardiography. The peak systolic pressure gradient between the apical and the basal chamber was 91 mmHg, and the peak systole pressure was higher in the apical chamber than in the basal chamber. However, a reverse pressure gradient was revealed between the two chambers during late systole and the relaxation period when the abnormal jet was demonstrated.

Cardiomyopathy, Hypertrophic↗
PubMed2004

A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography.

BACKGROUND: The finding of aortic regurgitation at a classical examination is a diastolic murmur. HYPOTHESIS: Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician. METHODS: In all, 243 asymptomatic patients (mean age 42 +/- 10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (> or = 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade < or = II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur. RESULTS: Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p=0.15). CONCLUSIONS: An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.

Adult↗
PubMed1993

Effect of dobutamine on left ventricular relaxation and filling phase in patients with ischemic heart disease and preserved systolic function.

The beneficial effects of dobutamine on left ventricular systolic and diastolic phases have been described in patients with congestive heart failure. Its influence on left ventricular diastolic phase in patients with preserved systolic function, absence of dys- or akinetic areas, and left ventricular dilatation has not yet been adequately investigated. Thus a simultaneous echo-Doppler and hemodynamic study was performed in 15 patients with ischemic heart disease and preserved systolic function in order to assess the effect of dobutamine on left ventricular relaxation and filling phase. The infusion of dobutamine at a rate of 10 micrograms/kg/min induced a marked inotropic action, as shown by the significant increase in positive dP/dt (from 1392 +/- 224 to 2192 +/- 295 mmHg/sec, p < 0.001), dP/dt/P (from 32 +/- 8.1 to 50 +/- 17 sec-1; p < 0.0001), and in peak of systolic pressure (from 143 +/- 25 to 168 +/- 36 mmHg; p < 0.005). In addition, dobutamine reduced the end-systolic volume index (from 30 +/- 16 to 26 +/- 19 ml/m2; p < 0.05), the end-systolic stress (from 222.2 +/- 65.3 to 198.4 +/- 84 g/cm2; p < 0.006), and had favorable effects on relaxation and the early filling phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Dobutamine↗
PubMed1985

Color-coded Doppler imaging of systolic flow patterns in hypertrophic cardiomyopathy.

We studied 11 patients with hypertrophic cardiomyopathy by color Doppler echocardiography (Group I: 6 patients with outflow obstruction, and Group II: 5 patients without outflow obstruction) to assess systolic structure and function as observed by cross-sectional echocardiography in relation to the flow dynamics. The structure and function included systolic anterior motion of mitral valve (SAM), midsystolic aortic valve closure (AoC), systolic cavity obliteration and the presence and timing of mitral incompetence. Their occurrence and timing was related to presence of aortic systolic flow and presence of turbulence. While all patients in Group I had SAM and turbulence, none of the patients in Group II had SAM nor turbulence. Early mitral incompetence appearing before SAM and turbulence, occurred in all patients of Group I and in none of Group II. Midsystolic aortic valve closure was only present in Group I and blood flow was unilaterally directed so that only 60% of aortic cross-sectional area showed blood flow. We conclude that mitral incompetence in hypertrophic cardiomyopathy in early systole is common when outflow gradient is present and is independent of mitral incompetence of mid- and late systole. During SAM, turbulence in the subaortic area and mid and late mitral incompetence occurred simultaneously. The midsystolic aortic valve closure was related to the unilaterally directed blood flow through the aortic cross-sectional area.

Adult↗
PubMedDate not supplied

Left ventricular end-systolic pressure-volume relationships as a measure of ventricular performance.

The extent to which conclusions about myocardial performance may be drawn from end-systolic pressure-volume relations was investigated. Left ventricular isovolumetric and end-systolic pressure-volume relationships were measured in the rat, under acute impairment of contractility (hexobarbital), at chronic pressure overload (spontaneously hypertensive rats), and at chronic volume overload (aorto-caval shunt). Our results confirm the classic conception of Otto Frank where the curves of the isovolumetric maxima and the curves of the end-systolic pressure-volume relations follow separate courses. Acute alterations in contractility can be detected from shifts in the end-systolic pressure-volume relations. In chronic pressure or volume overloaded hearts the end-systolic pressure-volume relations do not render conclusions about ventricular or myocardial performance since in chronically altered hearts, the course of the end-systolic pressure-volume relations is primarily influenced by geometric factors.

Animals↗
PubMedDate not supplied

Can coronary systolic-diastolic flow differences be predicted by left ventricular pressure or time-varying intramyocardial elastance?

In six isolated rabbit hearts perfused with a pressure source and Krebs-Henseleit as the perfusion medium, the effect of left ventricular pressure on coronary inflow in the maximally vasodilated bed was studied. This effect was determined from isovolumic beats, low afterloaded isobaric beats (afterload maintained at values below 10 mm Hg) and during cardiac arrest. For isovolumic beats end-diastolic left ventricular pressure was varied by means of an intraventricular balloon between 0-40 mm Hg and systolic left ventricular pressure varied between 90-130 mm Hg. In these ranges diastolic inflow decreased significantly 18 +/- 6% (mean +/- SD) with increasing pressure and systolic inflow could not be shown to depend on pressure (n = 6). For isobaric beats, diastolic and systolic inflow remained at values similar to those found for the isovolumic beats (n = 6). In the arrested heart inflow diminished 8 +/- 2% when the pressure in the left ventricle was increased from 0 to 40 mm Hg (n = 3). We conclude that systolic coronary inflow is hardly affected by left ventricular pressure. Systolic inflow decreased by the same amount in the isovolumically and isobarically beating heart, when cardiac contractility was enhanced by epinephrine infusion. We suggest the results can be explained on the basis of the time-varying elastance concept: systolic elastance is the same for isovolumic and isobaric beats but depends on contractility. Models that relate coronary inflow impediment to left ventricular pressure should therefore be reevaluated.

Animals↗
PubMedDate not supplied

Late systolic stress-diameter relation in patients with aortic valve disease before and after valve replacement.

The end-systolic pressure-diameter ratio (Ees) and the maximal pressure-diameter ratio (Emax) during systolic ejection were determined in 10 control patients and 25 patients with aortic valve disease before and 18 months after successful valve replacement. The pressure-diameter ratio was determined from simultaneous M-mode echocardiograms and high-fidelity pressure measurements. A new index of myocardial contractility, as proposed by Pouleur and co-workers, was assessed from the late systolic stress-diameter relationship during one single heart cycle. The slope of this stress-diameter relationship was used for determination of myocardial contractility. Meridional wall stress was calculated from echo-pressure measurements at time intervals of 5 to 10 msec. The aortic valve patients were divided into two groups according to the preoperative angiographic ejection fraction: group 1 (ejection fraction greater than or equal to 57%) consisted of 16 patients and group 2 (ejection fraction less than 57%) of 9 patients. Standard hemodynamics showed a significant decrease in left ventricular end-diastolic pressure from 18 to 11 mm Hg in group 1 (P less than 0.01) and from 16 to 12 mm Hg (NS) in group 2. Peak systolic pressure decreased from 186 to 135 mm Hg (P less than 0.01) in group 1 and from 155 to 140 mm Hg (NS) in group 2. Left ventricular end-diastolic volume decreased from 137 to 105 ml/m2 in group 1 and from 225 to 150 ml/m2 in group 2 (P less than 0.05) whereas left ventricular ejection fraction remained unchanged in group 1 (67 versus 65%) and increased slightly in group 2 (45 versus 51%) following surgery. Emax and Ees were preoperatively significantly decreased in group 2 when compared to group 1. Postoperatively, Emax and Ees were no longer significantly different between the two groups although left ventricular ejection fraction remained significantly depressed in group 2 after surgery when compared to group 1. The slope of the late systolic stress-diameter relationship (beta) and the diameter at zero stress (D0) did not show any difference between the two groups pre- as well as postoperatively. Thus it is concluded that Ees and Emax might help to identify myocardial dysfunction in preoperative patients with aortic valve disease. However, in the presence of persistent myocardial dysfunction, as evaluated from systolic ejection fraction, following successful valve replacement, both Ees and Emax do not allow to identify patients with postoperative depressed myocardial function.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Noninvasive evaluation of systolic pressures of pulmonary artery and right ventricle using contrast-enhanced doppler echocardiography: comparative study using sonicated albumin or glucose solution.

Evaluation of pulmonary arterial pressure is essential for the diagnosis and management of patients with congenital heart disease; it is usually done by cardiac catheterization. An alternative, noninvasive method may be clinically more useful. The purpose of this study was to assess the usefulness of the noninvasive determination of systolic pressure of the pulmonary artery and right ventricle by contrast-enhanced Doppler echocardiography. We selected 30 pediatric patients (28 with trivial or nonsignificant tricuspid regurgitant Doppler signals and 2 with significant tricuspid regurgitant Doppler signals) aged 2 months to 21 years. The flow velocity of tricuspid regurgitation was measured with continuous-wave Doppler of the right ventricular inflow view or left parasternal or apical four-chamber view before and after injection of two types of contrast medium (hand-agitated 5% glucose or sonicated albumin). The systolic pressure of the pulmonary artery was assessed as the estimated right ventricular systolic pressure (albumin method) minus the peak pressure gradient across the pulmonary valve (nonenhanced Doppler method). After injection of hand-agitated 5% glucose and sonicated albumin, trivial tricuspid regurgitation signals were enhanced in 25 of 28 patients (89%). In two patients, spectral envelopes were well defined enough to obtain the peak systolic velocity of the tricuspid regurgitation jet without contrast medium injection. Peak velocity was not altered by injection of contrast medium in these patients. There was significant correlation between the estimation by contrast-enhanced Doppler using hand-agitated 5% glucose and the cardiac catheterization measurement of the transtricuspid pressure gradient (r = 0.88). The transtricuspid pressure gradients obtained by continuous-wave Doppler during sonicated albumin enhancement corresponded closely to those measured by cardiac catheterization (r = 0.95). Pulmonary arterial and right ventricular systolic pressures measured by Doppler using sonicated albumin and those obtained by cardiac catheterization were highly correlated (right ventricle, r = 0.96; pulmonary artery, r = 0.95). In conclusion, this technique may be a valuable noninvasive method for determining accurate right ventricular and pulmonary arterial systolic pressures.

Adolescent↗
PubMed2002

Systolic versus diastolic blood pressure versus pulse pressure.

Elevation of systolic blood pressure (BP) has been recognized as an independent risk factor that far exceeds the risk associated with an elevated diastolic BP in older patients with hypertension. Isolated systolic hypertension (ISH) is a disorder typically defined when the systolic BP is greater than 140 mm Hg but with diastolic BP below 90 mm Hg. Pulse pressure (the difference between systolic and diastolic pressure) has recently become an active area of discussion in the literature as an independent factor of cardiovascular risk. An increased pulse pressure nearly always indicates reduced vascular compliance of large arteries and, by definition, is always increased in patients with isolated systolic hypertension. Although the evidence that a widened pulse pressure is an independent marker of cardiovascular risk is quite well established, therapeutic morbidity and mortality studies in ISH have focused on reductions in systolic pressure. At the present time, outcomes data have not been well established for reductions in pulse pressure in older patients with hypertension.

Blood Pressure↗
PubMed1987

Correlates of resting and maximal exercise systolic blood pressure after repair of coarctation of the aorta: a multivariable analysis.

Repair of coarctation of the aorta may not prevent the subsequent development of elevated systemic blood pressure at rest or with exercise. The correlates of late postoperative resting systolic blood pressure and maximal exercise systolic blood pressure levels were investigated in a retrospective study of 42 patients who had graded exercise tests after correction of coarctation of the aorta. The independent variables studied included height, weight, body surface area, age at surgery, age at exercise testing, the time interval between surgery and exercise testing, the highest systolic blood pressure prior to surgery, gradient across the coarctation at preoperative catheterization, and the residual postoperative gradient across the coarctation. The same combination of independent variables provided the best regression model for explanation of the variance of both postoperative resting and maximal exercise systolic blood pressure. The models included height, highest preoperative systolic blood pressure, and residual gradient. None of the other variables added significant explanatory ability to either model. These findings suggest that the preoperative level of systolic blood pressure may be the best determinant of timing the corrective surgery. It may be possible to defer the operation, as long as blood pressure remains normal, until an age when repair is less likely to result in recurrent coarctation.

Adolescent↗
PubMed1990

Evaluation of left ventricular diastolic function using an ambulatory radionuclide monitor: relationship to left ventricular systolic performance.

Abnormalities of left ventricular (LV) filling may occur prior to systolic dysfunction in patients with both coronary and noncoronary heart disease. To determine the incidence of diastolic dysfunction and to assess the relationship of such dysfunction to systolic performance, we measured systolic and diastolic function at rest in a series of healthy volunteers (n = 10) and in patients with cardiovascular disease (n = 42). Twenty patients had coronary artery disease (CAD) with prior myocardial infarction, six patients had CAD without myocardial infarction, and the remaining 16 patients had a variety of noncoronary heart diseases, including valvular heart disease, dilated cardiomyopathy, and hypertensive disease. The 42 patients manifested a wide variation in LV systolic function (ejection fractions ranged from 6% to 65%). Patients with reduced LV ejection fraction (EF) manifested a reduction in cardiac output and peak ejection rate proportionate to the reduction in EF. Diastolic function showed a fall in LV peak (PFR) and average (AFR) filling rates; these were reduced in proportion to the fall in EF. Heart rate was an insensitive index of the magnitude of impairment of LV systolic function. These data suggest that measurements of diastolic function do not provide additional information in patients with impaired systolic function.

Adult↗
PubMed1990

Left ventricular end-systolic stress-volume index ratio in aortic and mitral regurgitation with normal ejection fraction.

To evaluate the left ventricular contractile state in regurgitant valvular disease with normal ejection fraction, we analyzed the end-systolic stress-volume index relationship (ESSVR) by means of cineangiography in 15 normal subjects, 11 patients with aortic regurgitation (AR), and 10 patients with mitral regurgitation (MR) whose ejection fraction (EF) was 60% or more. The end-systolic stress-volume index ratio in normal subjects was 5.57 +/- 0.60 kdyne/cm5/m2 (mean +/- standard deviation), and we defined the range including +/- 2 standard deviations of the ratio as the normal ESSVR range. Six patients with AR and five patients with MR placed inside the normal ESSVR range, termed AR IN and MR IN, but the remaining five patients with AR and MR placed to the right of the normal range, termed AR OUT and MR OUT. EF did not differ between patients with AR IN and AR OUT (69.4 +/- 5.4 verus 70.7 +/- 6.1%) and between MR IN and MR OUT (71.6 +/- 3.6 versus 71.1 +/- 7.9%). The EF of the subdivided groups with AR and MR also did not differ from that of normal subjects (70.7 +/- 7.3%). This finding showed that the left ventricular contractile state was depressed in patients with AR OUT and MR OUT despite a normal EF. In AR and MR the end-systolic stress and end-systolic volume index of OUT did not differ from those of IN, but the end-diastolic volume index of OUT was larger than that of IN (AR OUT 156.8 +/- 27.9 versus AR IN 110.8 +/- 24.1 ml/m2, MR OUT 160.5 +/- 44.7 versus MR IN 101.0 +/ 16.6 ml/m2; both p less than 0.05), and the regurgitant fraction of OUT was higher than that of IN (AR OUT 52.6 +/- 13.6 versus AR IN 29.7 +/- 13.3%, MR OUT 52.9 +/- 10.2 versus MR IN 30.2 +/- 11.4%; both p less than 0.05). In addition, there was a linear inverse correlation between the end-systolic stress-volume index ratio and the end-diastolic volume index in all subjects (r = -0.82, n = 36). In normal subjects there was a linear inverse correlation between end-systolic stress and the EF (r = -0.91, n = 15), but this relationship failed to separate patients with OUT from those with IN. Results of the present study suggest that some patients with AR and MR whose EF was normal had a depressed contractile state, and these patients had a large end-diastolic volume index and a high regurgitant fraction.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Gender differences in the systolic blood pressure response to exercise.

Previous work has shown a gender difference in the normal cardiac response to exercise. Men had significantly higher absolute systolic blood pressure responses at 50%, 75%, and 100% peak heart rate on all modalities (p less than 0.05). This difference is absent when systolic blood pressure is adjusted for body surface area, is reduced when adjusted for body weights, and is reversed when systolic blood pressure is adjusted for lean body mass. The influence of gender on the systolic blood pressure response to dynamic exercise was independent of exercise modality. Men had a higher systolic blood pressure in spite of the fact that they had similar sympathetic nervous system response as indicated by urinary norepinephrine excretion. Gender differences in systolic blood pressure responses were altered when adjusted for body weight, body surface area, and lean body mass.

Blood Pressure↗
PubMed1991

Pathophysiology of isolated systolic hypertension in elderly patients: Doppler echocardiographic insights.

Systemic hemodynamics were evaluated with aortic pulsed wave Doppler echocardiography in 79 elderly subjects with isolated systolic hypertension participating in the Systolic Hypertension in the Elderly Program (SHEP) and were compared with the values in 39 normal age-matched subjects. Cardiac output was elevated (4.50 +/- 1.13 L/min versus 3.94 +/- 1.12 L/min, p less than 0.05) in patients with isolated systolic hypertension in comparison with values in normal elderly subjects. Systemic vascular resistance did not differ between both groups (2140 +/- 536 dyn.sec/cm-5 versus 2011 +/- 553 dyn.sec/cm-5, p = NS). The mean acceleration of blood during left ventricular ejection was similar in patients with isolated systolic hypertension in comparison with normals (12.6 +/- 5.6 m/sec2 versus 11.5 +/- 3.5 m/sec2, p = NS). Patients with isolated systolic hypertension had significantly decreased arterial compliance, as measured by the stroke volume-to-pulse pressure ratio (0.77 +/- 0.26 cm3/mm Hg versus 1.11 +/- 0.30 cm3/mm Hg, p less than 0.0001). The prevalence of aortic and mitral regurgitation as well as valvular and annular calcification did not differ between analyzed groups. Isolated systolic hypertension in elderly patients appears to be multifactorial, with reduced arterial compliance and increased cardiac output both playing a role.

Aged↗
PubMed1992

Survival of heart failure patients with preserved versus impaired systolic function: the prognostic implication of blood pressure.

The impact of impaired versus preserved systolic function on survival of patients with heart failure was investigated in 78 patients with decompensated heart failure. Patients were classified on the basis of their left ventricular systolic performance, as defined by fractional shortening (FS); group I (n = 56) had impaired systolic function (FS less than 24%) and group II (n = 22) had preserved systolic function (FS greater than or equal to 24%). Mean ejection fraction was 15 +/- 5% and 40 +/- 13% for these groups, respectively. By the end of 48 months, 36 patients in group I had died compared with only 22 patients in group II (p less than 0.05). Both systolic and diastolic blood pressure were significantly lower in the deceased patients compared with the survivors in group I (p less than 0.05). There was a trend for an opposite direction in the relationship of blood pressure to mortality in group II. We conclude that the prognosis of patients with heart failure and preserved systolic function is more favorable than that of those with impaired function, and that blood pressure may have a differential prognostic meaning in the two groups.

Blood Pressure↗