Background: Impaired diastolic filling is an important problem among elderly female hypertensives (EFH) which can lead to overt heart failure. High afterload may impair rapid relaxation of the left ventricle (LV) which delays LV filling. Over time, remodelling (LV hypertrophy, altered repolarisation) may add to the problem. We studied the determinants of impaired filling in EFH.

Methods: 17 stable EFH without clinical heart failure (age [mean ± SD] 66 ± 10 years; blood pressure [BP] 158±16 / 85±9 mmHg) underwent wave intensity analysis (WIA; NA: negative area produced by returning wave reflections during systole; Aloka SSD-5500, Tokyo, Japan), ECG (QTc: QT-interval indexed for heart rate [Bazett’s formula]; QRS-T angle: angle between QRS and T-wave axes in the frontal plane), and echocardiography (EDT: E-deceleration time, an index of LV filling; e’: tissue Doppler early diastolic lengthening at mitral annulus, an index of LV relaxation [averaged septal and lateral]).

Results: Subjects with delayed EDT had larger NA (r=−0.62, p=0.01), higher systolic BP (r=−0.51, p=0.038), higher heart rate (r=0.68, p=0.004), impaired relaxation (e’: r=−0.50, p=0.049), wider QRS-T angle (r=0.59, p=0.021) and longer QTc (0.53, p=0.042). Multivariable analysis showed that NA (β=−0.71, p<0.001) and e’ (β=−0.42, p=0.02) predicted delayed EDT, but not systolic BP (p=0.62) nor heart rate (p=0.82).

Conclusion: After adjusting for intrinsic impairment of relaxation (e’), NA remains a strong predictor of delayed diastolic filling in EHF. This underscores the importance of optimising systolic wave reflections in this group and suggests that WIA should be tried for monitoring of treatment effects.