Hemodynamic characteristics of the early phase of primary hypertension: The Dutch hypertension and offspring study

Background. The hemodynamic characteristics of the early phase of primary hypertension are subject to debate. In particular, it remains unclear whether an increased vascular peripheral resistance or a raised cardiac output is involved as the primary hemodynamic alteration in hypertension. Methods and Results. We studied hemodynamic characteristics and oxygen consumption in relation to 24-hour ambulatory blood pressure measurements in three groups of normotensive children with a different familial predisposition for hypertension. Selection of participants was based on parental blood pressure levels. Mean 24-hour blood pressure was higher in the offspring of two hypertensive parents compared with the offspring of two normotensive parents; there was a difference of 4.7 mm Hg (95% confidence interval [CI], 1.8-7.6) for systolic blood pressure and a difference of 4.8 mm Hg (CI, 2.3-7.3) for diastolic blood pressure. The 24-hour blood pressure pattern was consistently at a higher level for both systolic and diastolic blood pressures in the offspring of two hypertensive parents compared with the offspring of two normotensive parents. The smallest differences in blood pressure were seen at night, and the largest differences in blood pressure between the groups of offspring were seen during periods of physical activity. Echocardiographic examination combined with registration of oxygen consumption did not show a difference in cardiac index and arteriovenous oxygen difference between the study groups. However, differences in cardiac dimensions were apparent, with an increased left ventricular mass index (8.7 g/m²; CI, 2.4-15.0) in the offspring of two hypertensive parents. Conclusions. These findings do not support the existence of a hyperkinetic circulatory phase but may indicate the presence of an increased left ventricular mass in early primary hypertension.