Hypertensive Hypertrophic Cardiomyopathy of the Elderly

TLDR

Echocardiographic assessment of 21 elderly hypertensive patients revealed severe concentric hypertrophy, a small left‑ventricular cavity, and supernormal systolic function, with most subjects female and black, compared to age‑ and sex‑matched normotensive controls. The cohort exhibited markedly elevated ejection fractions (≈79% vs 59% in controls) and impaired diastolic filling, with 13 patients reporting dyspnea or chest pain; beta‑blocker or calcium‑channel blocker therapy relieved symptoms, whereas vasodilators induced severe hypotension and one fatality, underscoring the need for tailored management. Published in N Engl J Med 1985; 312:277–83.

Abstract

Using echocardiography, we identified 21 patients with a syndrome that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. Thirteen of the patients presented with dyspnea or chest pain. All patients studied had a history of hypertension and were compared with normotensive controls matched for age and sex. The patients were elderly (mean age, 73.3 years), predominantly female (16 patients), and mostly black (15 patients). Their cardiac function was characterized by excessive left ventricular emptying (ejection fraction on two-dimensional echocardiography [patients vs. controls], 79±4 vs. 59±5 per cent, P<0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279±25 vs. 160±45 msec, P<0.001) and reduced peak diastolic dimension increase (11±4 vs. 16±5 cm per second, P<0.05). In spite of the clinical presentation of heart failure, all of 9 patients receiving either beta-receptor antagonists or calcium-channel blocking agents obtained symptomatic relief, whereas 6 of 12 patients receiving vasodilator medications had severe hypotensive reactions, including one death. We conclude that this unique subset of hypertensive patients has a clinical syndrome that warrants recognition and tailored management. (N Engl J Med 1985; 312:277–83.)