The precise role that abnormal wall stress may play in the pathophysiology of hypertensive heart disease is not known. Hypertension is almost unique in that it ultimately affects all parts of the law of Laplace equation, i.e. intraventricular pressure changes and with the advent of left ventricular hypertrophy both internal radius and wall thickness alter. If heart failure supervenes the components of the equation change once more. This article will discuss the implications of abnormal wall stress at these various stages in hypertensive heart disease.
GhaliVKKadakiaSCooperRSLiaoY.Impact of left ventricular hypertrophy on ventricular arrhythmias in the absence of coronary artery disease. J Am Coll Cardiol1991; 17: 1277–1282.
11.
DunnFGMcLenachanJMIslesCGBrownIDargieHJLeverAF. Left ventricular hypertrophy and mortality in hypertension: an analysis of data from the Glasgow Blood Pressure Clinic. J Hypertens1990; 8: 775–782.
JamesMAMacConnellTJJonesJV.Is ventricular wall stress rather than left ventricular hypertrophy an important contributory factor to sudden cardiac death. Clin Cardiol1995; 18: 61–65.
14.
FaheyTPPetersTJ.What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ1996; 313: 93–96.
15.
Guidelines Sub-Committee: 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension.J Hypertens1999; 17: 151–183.
16.
BelkinRKissloJ.Clinical application of echocardiography in myocardial and valvular heart disease. Prog Cardiovasc Dis1986; 29: 81–106.
17.
An excellent paper describing in detail the methods for measuring left ventricular dimensions echocardiographically and clearly explaining how left ventricular mass is unrelated to left ventricular wall thickness, and giving the example of a dilated heart with a thin ventricular wall having a greater mass than a normal-sized heart with a thick ventricular wall. This demonstrates how an increase in left ventricular mass is frequently a reflection of left ventricular failure with dilatation of the ventricle rather than simply a measure of increase in muscle thickness. This explains why there is so much confusion surrounding the term left ventricular hypertrophy.
18.
VliegenHWvan der LaarseACornelisseCJEulderinkF.Myocardial changes in pressure overload induced left ventricular hypertrophy. Eur Heart J1991; 12: 488–494.
19.
HarrisonDGMarcusMLDellspergerKCLampingKGTomanekRJ.Pathophysiology of myocardial perfusion in hypertension. Circulation1991; 83 (suppl III): III14–III18.
20.
FrohlichE.Physiologic considerations in left ventricular hypertrophy. Am J Med1983; 75 (suppl 3A): 12–18.
21.
FribergPNordlanderM.Influence of left ventricular and coronary vascular hypertrophy on cardiac performance. J Hypertens1990; 8: 879–889.
22.
LoaldiAPepiMAgostiniPFiorentiniCGraziSBellaP. Cardiac rhythm in hypertension assessed through 24 hr ambulatory electrocardiography monitoring. Effects of load manipulation with atenolol, verapamil, and nifedipine. Br Heart J1983; 50: 118–126.
23.
This is a very important paper because the authors present the only study which has sensibly considered and allowed for the possibility of an interaction between the presence of thickening of the ventricular wall and dilatation of the left ventricular chamber. Accordingly they have shown, as would be expected from theoretical considerations, that the incidence of ventricular arrhythmia in hypertension was only increased when wall stress was raised as a consequence of left ventricular dilatation, whilst hypertensives with low wall stress due to left ventricular wall thickening but normal chamber sizes did not demonstrate an increase in arrhythmic activity. They also showed that following treatment arrhythmia activity could only be shown to improve when the treatment could be demonstrated to have reduced wall stress.
24.
LeenenF.Increased risk attributed to left ventricular hypertrophy in hypertension. Curr Opin Cardiol1996; 11: 464–470.
25.
LiaoYCooperRDurazo-ArvizuRMensahJAGhaliJK.Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol1997; 29: 641–650.
26.
HaiderAWLarsonMGBenjaminEJLevyD.Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol1998; 32: 1454–1462.
27.
EvansSJLeviAJJonesAV.Wall stress induced arrhythmia is enhanced by low potassium and early left ventricular hypertrophy in the working rat heart. Cardiovasc Res1995; 29: 555–562.
28.
SandlerHDodgeHT.Left ventricular tension and stress in man. Circ Res1963; 14: 91–104.
29.
This is an excellent review of exactly what constitutes wall stress, what factors influence it with the theoretical reasoning behind the equations that can be used to calculate it.
30.
JamesMAJonesJV.The paradoxical role of left ventricular hypertrophy in wall stress related arrhythmia. J Hypertens1992; 10: 167–172.
31.
JamesMAJonesJV.An interaction between LVH and potassium in hypertension?J Hum Hypertens1991; 5: 475–478.
32.
A clear review of all the evidence to support the notion that there is an interaction between hypertrophy of the myocardial cell and hypokalaemia which acts as a confounding factor in the assessment of the effects of left ventricular hypertrophy and consequently of wall stress in hypertension.
33.
SerafiASEvansSJJonesJV.Arrhythmogenic effect of ventriculography in patients with left ventricular dilatation and/or hypertension. Clin Sci1998; 95: 453–458.
34.
HortonR.Spinning the risks and benefits of calcium antagonists. Lancet1995; 346: 586.
35.
BeeversGSleightP.Short acting dihydropyridine (vasodilating) calcium channel blockers for hypertension: is there a risk. BMJ1996; 312: 1143–1145.
36.
LipGYHBeeversGSinghPWatsonRDS.ABC of atrial fibrillation: aetiology, pathophysiology and clinical features. BMJ1995; 311: 1425–1428.
