COMPARATIVE ECHOCARDIOGRAPHIC EVALUATION OF LEFT VENTRICULAR FUNCTION IN CONTROLLED AND UNCONTROLLED HYPERTENSION

Abstract

Background: Hypertension is associated with progressive structural and functional remodelling of the left ventricle, including hypertrophy, diastolic impairment, and a gradual decline in systolic performance. Echocardiography remains the principal non-invasive modality for detecting these cardiac changes at an early, reversible stage. Objective: To compare left ventricular structural and functional echocardiographic parameters between patients with controlled and uncontrolled hypertension. Methods: This comparative cross-sectional study was conducted at the Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology, Multan. A total of 200 hypertensive patients were enrolled through consecutive convenience sampling and divided into two equal groups of 100 each: controlled hypertension (mean SBP <140 mmHg and DBP <90 mmHg) and uncontrolled hypertension (mean SBP ≥140 mmHg and/or DBP ≥90 mmHg). All participants underwent standardized transthoracic echocardiography to assess left ventricular mass index (LVMI), ejection fraction (LVEF), and diastolic indices (E/A and E/e′ ratios). Data were analysed using SPSS v25.0; continuous variables were compared with the independent-samples t-test and the Mann-Whitney U test, and categorical variables with the chi-square test. A p-value <0.05 was considered significant. Results: Left ventricular hypertrophy was more prevalent in the uncontrolled group than the controlled group (70% vs 40%), with a correspondingly higher mean LVMI (125 ± 15 g/m² vs 95 ± 12 g/m²). Diastolic dysfunction was also more frequent in the uncontrolled group (63% vs 37%), reflected in a lower E/A ratio (0.9 ± 0.4 vs 1.2 ± 0.3) and a higher E/e′ ratio (18 ± 3 vs 12 ± 2). Mean LVEF was lower in the uncontrolled group (55 ± 7% vs 60 ± 5%), and systolic dysfunction was more prevalent (30% vs 10%). The Mann-Whitney U test confirmed a highly significant difference in median LVMI between groups (129.0 vs 91.0 g/m², p<0.0001). Conclusion: Uncontrolled hypertension is associated with significantly greater left ventricular hypertrophy, diastolic dysfunction, and early systolic impairment compared with controlled hypertension. These findings reinforce the value of sustained blood pressure control and routine echocardiographic surveillance in hypertensive patients