Citation: Supplement to Journal of the American College of Cardiology February 2000, Vol. 35, Issue 2, Suppl. A, page 332

Vittorio Palmieri, Donna K. Arnett, Jonathan N. Bella, Dalane W. Kitzman, Albert Oberman, Paul N. Hopkins, D.C. Rao, Mary Paranicas, Richard B. Devereux

For HyperGEN Investigators; Weill Medical College of Cornell University, New York, NY, USA

Background: Relation of Aortic (A) or Mitral (M) regurgitation (r) to body composition is controversial. Few data are available in population-based samples of hypertensive adults.

Methods: Among ambulatory hypertensive participants ([HYP]; blood pressure [BP] > 140 or 90 mmHg, or treatment) in the Hypertension Genetic Epidemiology Network, 2087 were selected for the study, 96% were on treatment, 20% had also type II Diabetes. A and/or M stenosis > than mild by echocardiography were exclusion criteria. Fat-free body mass (FFM) was assessed by bio-impedance and adipose mass derived as body weight-FFM. Color-Doppler was used to grade MR. Left ventricular (LV) mass, end-systolic stress and Doppler LV ejection time were used to estimate myocardial energy expenditure (MEE) in cal/beat.

Results: 1613 HYP had no AR and no MR (reference group); 360 HYP (17%) had no more than mild AR and/or MR; 114 HYP (5%) had moderate to severe AR and/or MR. From the reference group to those with moderate-severe AR and/or MR, age increased (53 vs 58 vs 61 y, p < 0.01) while body mass index (32.5 vs 30.2. vs 28.6 kg/m2, p < 0.01), FFM (56 vs 54 vs 53 kg, p < 0.05 for trend) and adipose mass (34 vs 30 vs 26 kg, p < 0.01) decreased; systolic BP did not differ, diastolic BP decreased (75 vs 74 vs 71 mmHg) and pulse pressure increased (57 vs 60 vs 62 mmHg) (both p < 0.05 for trend). From the reference group to those with moderate to severe AR and/or MR, LV mass index (43 vs 47 vs 52 g/m2.7), end-systolic stress (163 vs 172 vs 198 kdynes/cm2), and MEE (198 vs 224 vs 283 cal/min) increased (all p < 0.01) while ejection fraction (62 vs 60 vs 55%, p < 0.01) decreased. Prevalences of self-reported heart attack (7 vs 11 vs 21%) and LV hypertrophy (29 vs 40 vs 60%) increased from the reference group to those with moderate-severe valve disease (both p < 0.01).

Conclusions: In hypertensive adults, AR and/or MR are common. Even mild AR or MR is associated with tendency to greater LV hypertrophy and myocardial energy expenditure, and lower body adiposity. The increase in MEE contributes to change in body composition and lower body weight while LV hypertrophy increases risk of morbidity.