High-normal blood pressure impacts the right heart mechanics: a three-dimensional echocardiography and two-dimensional speckle tracking imaging study.

Objective: The aim of this study was to examine the relationship between increasing blood pressure (BP) and right ventricular (RV) and right atrial (RA) mechanics using two-dimensional echocardiography (2DE) strain analysis and three-dimensional echocardiography (3DE).

Methodology: This cross-sectional study included 58 individuals with optimal BP, 57 individuals with high-normal BP, and 59 recently diagnosed untreated hypertensive patients of similar age and sex distribution. Data were analyzed according to 24-h systolic blood pressure values (cutoff values were 120 and 130 mmHg). All individuals underwent complete 2DE and 3DE examination.

Results: The global longitudinal RV strain decreased gradually from controls, to high-normal BP individuals, to hypertensive patients, whereas systolic and early diastolic strain rates were similar between high-normal BP and hypertensive patients, but decreased in comparison with optimal BP individuals. The same trend was observed for the global longitudinal RA strain and systolic and early diastolic strain rates. 3DE examination revealed that RV volumes were increased in hypertensive patients in comparison with optimal BP individuals, which resulted in a lower 3DE RV ejection fraction in hypertensive patients. Multivariate analysis showed that the RV wall thickness was the only echocardiographic parameter that was, in the same time, independently associated with global RV and RA strain, and RV diastolic function.

Conclusion: The right heart deformation is significantly impaired in individuals with high-normal BP. This subclinical impairment of RV and RA mechanics and function in high-normal BP individuals seems to be similar to the impairment found in recently diagnosed hypertensive patients.