Elevated Pulmonary Artery Pressure: Discussion (Part 4)
In the present analysis, it is apparent that the presence of LVH and increased PAMP have both an independent and an interactive effect on mortality. The interactive effect of LVH and elevated PAMP is best illustrated by the estimated fivefold increase in mortality when these two conditions coexist. Although the nature of this interaction is undoubtedly complex, it is possible that myocardial thickness is not a very accurate measure of compliance under the conditions of this study. Some individuals may respond to the pressure overload of hypertension with hypertrophy, while others will not. It is also now well known that echo-LV mass is not highly correlated with blood pressure, at least as measured short term. None of these cardiac abnormalities therefore can be reliably ascribed in quantitative terms to the lifetime effect of hypertension. birth control yasmin
Beyond these methodologic limitations, it is clear that the state of the myocardium of our patients is determined by a complex mixture of the effects of ischemic and hypertensive heart disease. Many patients will have experienced periods of sustained hypertension in the past, along with intermittent blood pressure control. Myocardial hypertrophy and subsequent regression probably occurred in most patients and may have resulted in an increase in myocardial collagen content that contributed to loss of compliance.