European Journal of Cardiovascular Medicine

Hypertension, defined as persistently elevated blood pressure, is a prevalent cardiovascular condition with significant implications for cardiac anatomy and function. Globally, hypertension is responsible for considerable morbidity and mortality, being a major risk factor for conditions such as myocardial infarction, stroke, heart failure, and chronic kidney disease [1]. The structural and functional cardiac changes associated with hypertension, commonly referred to as hypertensive heart disease, primarily include left ventricular hypertrophy (LVH), increased myocardial mass, and changes in cardiac dimensions [2]. The anatomical alterations observed in hypertensive patients are largely attributed to sustained pressure overload, which leads to adaptive remodeling of the cardiac chambers and walls. Left ventricular hypertrophy, the most commonly observed anatomical alteration, is characterized by an increase in myocardial wall thickness, especially of the interventricular septum and posterior wall, and subsequent changes in cardiac chamber dimensions [3]. Such anatomical variations significantly impact cardiac function and are predictive of adverse cardiovascular outcomes [4]. Studies comparing anatomical variations between hypertensive and normotensive individuals have provided valuable insights into understanding the progression of hypertensive heart disease. Echocardiographic assessments, magnetic resonance imaging (MRI), and computed tomography (CT) scans have all been utilized extensively to evaluate these differences [5]. Among these modalities, echocardiography remains the most widely used diagnostic tool due to its accessibility, cost-effectiveness, and ability to provide detailed information about cardiac anatomy, including ventricular dimensions, wall thickness, and myocardial mass [6]. Previous research indicates significant anatomical differences in heart structure between hypertensive and normotensive populations, including increased left ventricular mass, reduced ventricular compliance, and altered ventricular geometry such as concentric or eccentric hypertrophy [7]. These changes are not only diagnostic markers of hypertension-induced cardiac remodeling but also strong independent predictors of cardiovascular morbidity and mortality [8].

The implications of these anatomical variations extend beyond mere structural changes, impacting cardiac function and clinical outcomes significantly. Left ventricular hypertrophy and other structural changes in the heart associated with hypertension predispose individuals to arrhythmias, ischemic heart disease, heart failure, and sudden cardiac death [9]. Consequently, a detailed anatomical understanding of hypertensive heart disease is crucial for the early identification of high-risk patients, enabling timely interventions aimed at mitigating adverse outcomes [10]. Despite extensive research, there remain gaps in comparative anatomical data between hypertensive and normotensive individuals across diverse populations, particularly in relation to specific cardiac structural parameters. Additionally, the interplay between demographic factors such as age, gender, and ethnicity with hypertension-related anatomical variations requires further exploration to provide a comprehensive risk assessment model [11].

Therefore, the present study was designed to systematically evaluate and compare the anatomical variations of the heart in hypertensive and normotensive individuals. Utilizing robust imaging methodologies, this study aimed to elucidate detailed cardiac anatomical differences, providing insights that could inform clinical management and improve prognostic stratification.

Aim: To compare anatomical variations of the heart between hypertensive and normotensive individuals.

Objectives:

• To assess cardiac anatomical parameters such as left ventricular wall thickness, chamber dimensions, and ventricular mass in hypertensive individuals.
• To compare these anatomical parameters with those observed in normotensive individuals.
• To evaluate the correlation between hypertension duration and severity with observed cardiac anatomical variations.

·         Source of Data: Medical records and echocardiographic imaging results from patients attending cardiology outpatient and inpatient departments.

·         Study Design: Comparative cross-sectional study.

·         Study Duration: December 2023 to December 2024.

·         Sample Size: Total of 200 participants (100 hypertensive and 100 normotensive individuals).

Inclusion Criteria:

·         Patients aged 18-65 years.

·         Confirmed diagnosis of hypertension according to JNC VIII guidelines.

·         Normotensive controls with no history of cardiovascular disease.

Exclusion Criteria:

·         Patients with secondary hypertension.

·         Individuals with structural heart disease not related to hypertension (valvular heart diseases, congenital heart defects).

·         Participants with diabetes mellitus or chronic kidney disease.

Procedure and Methodology: Participants underwent detailed clinical examination, followed by echocardiographic assessment. Standard echocardiographic protocols, including measurements of left ventricular wall thickness, left ventricular mass, chamber dimensions, and ejection fraction, were followed as per ASE/EACVI guidelines.

Sample Processing: All echocardiographic images were digitally stored, anonymized, and analyzed independently by two experienced cardiologists, blinded to clinical status to minimize bias.

Statistical Methods: Data were analyzed using SPSS software version 26. Descriptive statistics were computed, and comparative analyses were performed using independent t-tests and Chi-square tests. Pearson correlation was used to assess relationships between hypertension duration/severity and cardiac anatomical changes.

Data Collection: Structured proformas were used to document demographic data, clinical history, blood pressure measurements, and echocardiographic findings, ensuring consistency and accuracy in data capture.

Table 1: To compare anatomical variations of the heart between hypertensive and normotensive individuals (N=200)

The present study involved a total of 200 individuals, equally divided into hypertensive and normotensive groups, to compare the anatomical variations of the heart. As demonstrated in Table 1, the mean age was significantly higher in hypertensive patients (51.4 ± 7.7 years) compared to normotensive individuals (48.9 ± 8.7 years), with a statistically significant difference (95% CI: 0.2–4.8; p=0.033). Gender distribution showed a slight male predominance among hypertensive patients (51%) compared to normotensive individuals (48%), though this difference was not statistically significant (p=0.227).

Table 2: To assess cardiac anatomical parameters such as left ventricular wall thickness, chamber dimensions, and ventricular mass in hypertensive individuals (N=100)

Table 2 specifically assessed cardiac anatomical parameters in hypertensive individuals (N=100). The mean left ventricular wall thickness was recorded as 12.4 mm (±2.0), left ventricular mass averaged 216.8 g (±34.4), and chamber dimension averaged 51.1 mm (±3.7). These parameters were quantified to provide baseline anatomical data among the hypertensive participants.

Table 3: To compare these anatomical parameters with those observed in normotensive individuals (N=200)

When comparing these cardiac anatomical parameters between hypertensive and normotensive individuals (Table 3), significant differences emerged. The mean left ventricular wall thickness was substantially higher in hypertensive patients (12.4 ± 2.0 mm) compared to normotensive controls (9.8 ± 1.2 mm), with a highly significant difference (95% CI: 2.2–3.0; p<0.001). Similarly, hypertensive patients had a notably greater mean left ventricular mass (216.8 ± 34.4 g) compared to normotensive participants (167.7 ± 20.9 g), again statistically significant (95% CI: 41.8–56.5; p<0.001). Chamber dimension measurements were also significantly larger in hypertensive patients (51.1 ± 3.7 mm) versus normotensive individuals (48.0 ± 3.9 mm), with a notable difference (95% CI: 2.0–4.2; p<0.001).

Table 4: To evaluate the correlation between hypertension duration and severity with observed cardiac anatomical variations (N=100 Hypertensive individuals)

Further analysis of hypertensive individuals (Table 4) evaluated the correlation between hypertension duration and severity with observed cardiac anatomical variations. Significant positive correlations were observed between hypertension duration and left ventricular wall thickness (Pearson’s r=0.58; 95% CI: 0.44–0.69; p<0.001), left ventricular mass (r=0.62; 95% CI: 0.49–0.72; p<0.001), and chamber dimension (r=0.47; 95% CI: 0.31–0.60; p<0.001). Likewise, hypertension severity showed strong positive correlations with left ventricular wall thickness (r=0.64; 95% CI: 0.51–0.74; p<0.001), left ventricular mass (r=0.67; 95% CI: 0.56–0.76; p<0.001), and chamber dimension (r=0.52; 95% CI: 0.37–0.64; p<0.001). These findings indicate that increased hypertension duration and severity are significantly associated with greater alterations in cardiac anatomical parameters.

In Table 1, the mean age of hypertensive individuals (51.4 ± 7.7 years) was significantly higher than that of normotensive individuals (48.9 ± 8.7 years), with a p-value of 0.033, suggesting that the likelihood of hypertension increases with age. This is consistent with the findings of Mills et al. (2020) ^[1], who documented an age-related rise in hypertension prevalence globally. The gender distribution did not show a significant difference (p=0.227), which supports data from Mureddu et al. (2014) ^[2], who found comparable prevalence among male and female subjects in early-stage hypertensive heart disease.

Table 2: Cardiac Anatomy in Hypertension

Table 2 focused on left ventricular wall thickness, mass, and chamber dimensions in hypertensive patients. The average LV wall thickness of 12.4 mm is consistent with findings from Devereux & Roman (2017) ^[3], who described hypertensive heart disease as typically presenting with wall thickness >11 mm. The LV mass average of 216.8 g falls within the hypertrophy range cited by Vakili et al. (2001)^[4], who established that LV mass >200 g is associated with significantly increased cardiovascular risk. The mean chamber dimension of 51.1 mm also aligns with concentric remodeling described in Ganau et al. (1992) ^[5].

Table 3: Comparative Anatomy between Hypertensive and Normotensive Individuals

The third table revealed statistically significant differences in all anatomical parameters between the two groups:

LV Wall Thickness: Hypertensive individuals had a significantly thicker ventricular wall (12.4 mm vs. 9.8 mm; p<0.001). This finding echoes the work of Drazner (2011) ^[6], who reported that wall thickening is a hallmark of adaptive cardiac remodeling under pressure overload.

LV Mass: The marked difference in LV mass (216.8 g in hypertensives vs. 167.7 g in normotensives; p<0.001) corroborates results from the Framingham Heart Study by Levy et al. (1990) ^[7], which identified LV mass as a potent predictor of cardiovascular events in hypertensive patients.

Chamber Dimensions: The increased chamber size (51.1 mm vs. 48.0 mm; p<0.001) in hypertensives reflects mild dilation, suggesting early compensatory mechanisms, as described by Koren et al. (1991) ^[8].

Table 4: Correlation with Hypertension Duration and Severity

Table 4 explored how the duration and severity of hypertension correlated with cardiac structural changes. Notable correlations were found:

LV Wall Thickness correlated significantly with both duration (r=0.58) and severity (r=0.64) of hypertension (p<0.001). This finding supports data by Katholi & Couri (2011) ^[9], who described progressive myocardial thickening with prolonged and severe hypertension.

LV Mass also showed strong correlations with both duration (r=0.62) and severity (r=0.67), reflecting findings from Marwick et al. (2015) ^[10] that emphasize mass as a cumulative marker of hemodynamic stress.

Chamber Dimension had slightly lower but still significant correlations with duration (r=0.47) and severity (r=0.52), suggesting that volume changes follow mass and wall thickness in the adaptive process.

This comparative study provides valuable insights into the anatomical variations of the heart between hypertensive and normotensive individuals. The findings demonstrate that hypertension significantly alters cardiac structures, with hypertensive individuals exhibiting increased left ventricular wall thickness, left ventricular mass, and chamber dimensions compared to their normotensive counterparts. These differences are statistically significant and align with previous research, which has documented the progressive changes in heart anatomy as a result of sustained hypertension. Furthermore, the study highlights a positive correlation between the duration and severity of hypertension and the observed cardiac structural changes. The results underscore the importance of early diagnosis and management of hypertension to prevent or mitigate the adverse effects on cardiac morphology, which can contribute to increased morbidity and mortality. This study also reinforces the need for regular cardiovascular assessments in hypertensive patients to monitor the progression of heart disease and guide appropriate therapeutic interventions.

1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237.
2. Drazner MH. The progression of hypertensive heart disease. Circulation. 2011;123(3):327-334.
3. Devereux RB, Roman MJ. Left ventricular hypertrophy in hypertension: stimuli, patterns, and consequences. Hypertens Res. 2017;40(10):779-785.
4. Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension. J Clin Hypertens. 2011;13(1):66-72.
5. Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(6):577-605.
6. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-270.
7. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19(7):1550-1558.
8. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141(3):334-341.
9. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561-1566.
10. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114(5):345-352.
11. Mureddu GF, Agabiti N, Rizzello V, et al. Prevalence of preclinical and clinical heart disease in subjects with hypertension in a population-based study. J Hypertens. 2014;32(10):2109-2116.
12. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237.