Cardiac structure and function in animal models and in human hypertension

Basic concepts
  • P. I. Korner
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 98)

Abstract

The left ventricle (LV) in hypertension has to pump against a chronically increased workload, so that a priori, we would expect LV hypertrophy (LVH) to be an inevitable consequence of hypertension. Yet the reported prevalence of LVH in human hypertension is relatively low, much more so than in animal models. The first part of this chapter considers possible reasons for the apparent paradox. Similarly, if we regard LVH as a physiological response to hypertension, LV myocardial function would be expected to be either normal or enhanced. But here too there is no consensus, with divergent conclusions based on studies in humans and animals. The experimental conditions under which LV function has often been compared, probably contribute to the above differences. For example, the performance of the normal and LVH heart have often been assessed under different loading conditions, as discussed in the second part of the chapter. However, there are problems of oxygen delivery through the coronary circulation, which ultimately set limits on myocardial performance. The last part of the chapter considers regression of myocardial hypertrophy during anti-hypertensive drug therapy and whether this should be an explicit therapeutic target in management.

Keywords

Mean Arterial Pressure Cardiac Index Fractional Shorten Leave Atrial Pressure Left Ventricle Mass 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bugaisky L, Zak R (1986): Biological mechanisms of hypertrophy, in: Fozzard HA, Jennings RB, Haber H, Katz AM (eds), The Heart and Cardiovascular System, pp 1491–1506. New York, Raven Press.Google Scholar
  2. 2.
    Wikman Coffelt J, Parmley WW, Mason DT (1979): The cardiac hypertrophy process: Analyses of factors determining pathological vs. physiological development. Circ Res 45: 697–707.PubMedGoogle Scholar
  3. 3.
    Tarazi RC, Sen S (1979): Catecholamines and cardiac hypertrophy, in: Catecholamines and the Heart, No 8 (Royal Society of Medicine International Congress and Symposium Series). Academic Press and Royal Society of Medicine, London.Google Scholar
  4. 4.
    Schreiber SS, Evans CD, Oratz M, Rothschild MA (1981): Protein synthesis and degradation in cardiac stress. Circ Res 48: 601–611.PubMedGoogle Scholar
  5. 5.
    Lundgren Y, Hallbäck M, Weiss L, Folkow B (1974): Rate and extent of adaptive cardiovascular changes during experimental renal hypertension. Acta Physiol Scand 91: 103–115.PubMedCrossRefGoogle Scholar
  6. 6.
    Folkow B, Hallbäck M (1977): Physiopathology of hypertension in rats, in: Genest J, Koiw E, Kuchel O (eds), Hypertension, pp 507–529. New York: McGraw Hill.Google Scholar
  7. 7.
    Fletcher PJ, Korner PI, Angus JA, Oliver JR (1976): Changes in cardiac output and total peripheral resistance during development of renal hypertension in the rabbit: Lack of conformity with the autoregulation theory. Circ Res 39: 633–639.PubMedGoogle Scholar
  8. 8.
    Korner PI, Oliver JR, Casley DJ (1980): Effect of dietary salt on hemodynamic of established renal hypertension in the rabbit: Implications for the autoregulation theory of hypertension. Hypertension 2: 794–801.PubMedGoogle Scholar
  9. 9.
    Broughton A, Korner PI (1983): Basal and maximal inotropic state in renal hypertensive dogs with cardiac hypertrophy. Am J Physiol 245: H33–H41.PubMedGoogle Scholar
  10. 10.
    Sen S, Tarazi RC, Khairallah PA, Bumpus FM (1974): Cardiac hypertrophy in spontaneously hypertensive rats. Circ Res 35: 775–781.PubMedGoogle Scholar
  11. 11.
    Pfeffer MA, Frohlich ED (1972): Hemodynamic and myocardial function in young and old normotensive and spontaneously hypertensive rats. Circ Res 32(suppl. I): I 28–I 35.Google Scholar
  12. 12.
    Adams MA, Bobik A, Korner PI (1988): Differential development of vascular and cardiac hypertrophy in the spontaneously hypertensive rat: Relationship to regional sympathetic function. Hypertension (in press).Google Scholar
  13. 13.
    Pickering GW (1968): High Blood Pressure, 2nd ed. London: J. & A. Churchill.Google Scholar
  14. 14.
    Levine RA, Gillam LD, Weyman A (1986): Echocardiography in cardiac research, in: Fozzard HA, Jennings RB, Haber H, Katz AM (eds), The Heart and Cardiovascular System, pp 369–452. New York: Raven Press.Google Scholar
  15. 15.
    Ali-Sambra F, Fouad FM, Tarazi RC (1983): Determinants of left ventricular hypertrophy and function in hypertensive patients. Am J Med 75(Suppl 3A): 26–43.Google Scholar
  16. 16.
    Hammond IW, Devereux RB, Alderman MH, Lutas EM, Spitzer MC, Crowley JS, Laragh JH (1986): The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension. J Am Coll Cardiol 7: 639–650.PubMedCrossRefGoogle Scholar
  17. 17.
    Devereux RB, Casale PN, Hammond IW, Savage DD, Alderman MH, Campo E, Alonso DR, Laragh JH (1987): Echocardiographic detection of pressure overload left ventricular hypertrophy: Effect of criteria and patient population. J Clin Hypertens 3: 66–78.PubMedGoogle Scholar
  18. 18.
    Laufer E, Jennings GL, Korner PI, Dewar E (1989): Prevalence of cardiac structural and functional abnormalities in untreated primary hypertension. Hypertension 13: 151–162.PubMedGoogle Scholar
  19. 19.
    Fisher RA (1946): Statistical Methods for Research Workers, pp 285–298. Edinburgh: Oliver and Boyd.Google Scholar
  20. 20.
    Korner PI (1983): The role of the heart in hypertension, in: Robertson JIS (ed), Handbook of Hypertension, Vol 1: Clinical Aspects of Essential Hypertension, pp 97–132. Amsterdam: Elsevier.Google Scholar
  21. 21.
    Weber KT, Janicki JS, Shroff SG (1986): Measurement of ventricular function in the experimental laboratory, in: Fozzard HA, Jennings RB, Haber H, Katz AM (eds), The Heart and Cardiovascular System, pp 865–886. New York: Raven Press.Google Scholar
  22. 22.
    Smith V-E, Weisfeldt ML, Katz AM (1986): Relaxation and diastolic properties of the heart, in: Fozzard HA, Jennings RB, Haber H, Katz AM (eds), The Heart and Cardiovascular System, pp 803–818. New York: Raven Press.Google Scholar
  23. 23.
    Brutsaert DL, Paulus WJ (1979): Contraction and relaxation of the heart as a muscle and pump. Int Rev Physiol 18: 1–31.PubMedGoogle Scholar
  24. 24.
    Brady AJ (1968): Active state in cardiac muscle. Physiol Rev 48: 570–600.PubMedGoogle Scholar
  25. 25.
    Mason DT, Braunwald E, Covell JW, Sonnenblick EH, Ross J Jr (1971): Assessment of cardiac contractility: The relation between the rate of pressure rise and ventricular pressure during isovolumic systole. Circulation 44: 47–58.PubMedGoogle Scholar
  26. 26.
    Sagawa K (1978): The ventricular pressure volume diagram revisited. Circ Res 43: 677–687.PubMedGoogle Scholar
  27. 27.
    Esler M, Jennings G, Korner P, Willett I, Dudley F, Hasking G, Anderson W, Lambert G (1988): Assessent of human sympathetic nervous system activity from measurements of norepinephrine turnover. Hypertension 11: 3–20.PubMedGoogle Scholar
  28. 28.
    Broughton A, Korner PI (1981): Estimation of maximum inotropic responses from changes in isovolumic indices of contractility in the dog. Cardiovasc Res 15: 382–389.PubMedCrossRefGoogle Scholar
  29. 29.
    Broughton A, Korner PI (1986): Left ventricular pump function in renal hypertensive dogs with cardiac hypertrophy. Am J Physiol 251: H 1260–H 1266.Google Scholar
  30. 30.
    Folkow B (1982): Physiological aspects of primary hypertension. Physiol Rev 62: 347–504.PubMedGoogle Scholar
  31. 31.
    Korner PI (1982): Causal and homeostatic factors in hypertension. Clin Sci 63(Suppl 8): 5s–26s.PubMedGoogle Scholar
  32. 32.
    Mulvany MJ (1987): The structure of the resistance vasculature in essential hypertension. J Hypertension 5: 129–136.CrossRefGoogle Scholar
  33. 33.
    Hallbäck-Nordlander M, Noresson E, Thoren P (1979): Hemodynamic consequences of left ventricular hypertrophy in spontaneously hypertensive rats. Am J Cardiol 44: 986–993.PubMedCrossRefGoogle Scholar
  34. 34.
    Averill DB, Ferrano CM, Tarazi RC, Sen S, Bajbus R (1976): Cardiac performance in rats with renal hypertension. Circ Res 38: 280–288.PubMedGoogle Scholar
  35. 35.
    Ferrano CM, Spech MM, Tarazi RC, Doi Y (1979): Cardiac pumping ability in rats with experimental renal and genetic hypertension. Am J Cardiol 44: 979–985.CrossRefGoogle Scholar
  36. 36.
    Elzinga G, Westerhof N (1976): The pumping ability of the left heart and the effect of coronary occlusion. Circ Res 38: 297–302.PubMedGoogle Scholar
  37. 37.
    Strauer BE (1981): The Heart in Hypertension, pp 251–284. Berlin: Springer Verlag.Google Scholar
  38. 38.
    Feigl E (1983): Coronary physiology. Physiol Rev 63: 1–205.PubMedGoogle Scholar
  39. 39.
    Smolich JJ, Weissberg PL, Broughton A, Korner PI (1988): Aortic pressure reduction redistributes transmural blood flow in dog left ventricle. Am J Physiol 254: H 361–H 368.Google Scholar
  40. 40.
    Smolich JJ, Weissberg PL, Broughton A, Korner PI (1988): Comparison of left and right ventricular blood flow responses during arterial pressure reduction in the autonomically blocked dog: Evidence for right ventricular autoregulation. Cardiovasc Res 22: 17–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Jennings GL, Esler MD, Korner PI (1980): Effect of prolonged treatment on haemodynamics of essential hypertension before and after autonomic block. Lancet 1980/2: 166–169.CrossRefGoogle Scholar
  42. 42.
    Jennings G, Korner P, Esler M, Restall R (1984): Redevelopment of essential hypertension after cessation of longterm therapy: Preliminary findings. Clin Exp Hypertens A6: 493–505.CrossRefGoogle Scholar
  43. 43.
    Korner PI, Jennings GL, Esler MD, Bobik A, Adams M (1987): The role of cardiovascular hypertrophy in hypertension: Basis for a new therapeutic strategy. J Cardiovasc Pharmacol 10(Suppl 5): S72–S78.Google Scholar
  44. 44.
    Korner PI, Jennings GL, Esler MD, Anderson WP, Bobik A, Adams M, Angus JA (1987): The cardiovascular amplifiers in human primary hypertension and their role in a strategy for detecting the underlying causes. Can J Physiol Pharmacol 65: 1730–1738.PubMedCrossRefGoogle Scholar
  45. 45.
    Sen S, Tarazi RC, Bumpus FM (1977): Cardiac hypertrophy and antihypertensive therapy. Cardiovasc Res 11: 427–431.PubMedCrossRefGoogle Scholar
  46. 46.
    Motz W, Strauer B (1984): Regression of structural cardiovascular changes by antihypertensive therapy. Hypertension 6(suppl III): III 133–III 139.Google Scholar
  47. 47.
    Tarazi RC, Fouad FM (1984): Reversal of cardiac hypertrophy in humans. Hypertension 6(suppl III): III 140–III 146.Google Scholar
  48. 48.
    Fletcher PJ (1984): Baroreceptor heart rate reflex in rabbits after reversal of renal hypertension. Am J Physiol 246: H 261–H 266.Google Scholar

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© Kluwer Academic Publishers 1989

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  • P. I. Korner

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