Abstract 6261: Impact of Waist Circumference on Cardiac Phenotype in Hypertensives According to Gender. Insights from the Hippokration Hellenic Hypertension (3H) Study
Obesity and hypertension deteriorate left ventricular (LV) structure and function in an additive manner increasing the risk of congestive heart failure. There is a sex-specific role of excess visceral fat accumulation in hypertension-induced cardiac adaptations A total of 1789 consecutive, non-diabetic, essential hypertensives (aged 55.8±13.5 years, 966 females), that were included in the 3H Study, were classified to obese and non-obese according to ATP III criteria regarding waist circumference value (>88 cm for obese women and >102 cm for obese men). In all participants, LV mass index (LVMI) and relative wall thickness were determined, while LV diastolic function was evaluated by means of conventional Doppler and tissue Doppler imaging (TDI), averaging early and late diastolic mitral annular peak velocities (Em, Am, Em/Am ratio) from four separate sites of measurement (septal, lateral, anterior and inferior walls). Hypertensive obese women (n=599) compared with non-obese (n=367) exhibited significantly greater LVMI and a higher prevalence of LV hypertrophy (by 5.5gr/m2 and 8.8%, p=0.003 and 0.005, respectively), while such differences were not present between hypertensive obese (n=415) and non-obese (n=408) men. Among hypertensive women, obese compared to non-obese were accompanied by significantly lower ratios of transmitral E/A (by 0.08 p<0.001), TDI derived Em/Am (by 0.12, p<0.001) and higher ratio of E/Em (by 0.8, p=0.016). In contrast, hypertensive obese men compared to non-obese exhibited only lower E and Em (by 0.04m/s and 0.6cm/s, both p<0.05). A significant interaction between sex and abdominal obesity was observed only regarding TDI-derived Am and Em/Am (p<0.05 for both). Waist circumference along with age and hemodynamic variables was a predictor of E/A (β=−0.097, p=0.002) and Em/Am (β=−0.116, p=0.001), independently of body size, in females but not in males. The adverse effect of abdominal obesity on LV structural and functional alterations is more pronounced among hypertensives of the female gender suggesting that routine measurement of waist circumference provides additional information on cardiac phenotype especially in women.