Diastolic Dysfunction in Patients with Hypertension Assessed by 2D Echo and Doppler Imaging and its Association with Clinical Profile and ECG Findings: A Cross-sectional Study

Introduction: Hypertension is a major risk factor for cardiovascular diseases and is strongly associated with Diastolic Dysfunction (DD), which can lead to Heart Failure with preserved Ejection Fraction (HFpEF). Despite its clinical significance, DD often remains underdiagnosed, necessitating routine echocardiographic screening for early detection. Aim: To evaluate the prevalence of DD in hypertensive patients using 2 Dimensional (2D) echocardiography and doppler imaging, along with its association with clinical characteristics and Electrocardiogram (ECG) findings. Materials and Methods: The present cross-sectional analytical study was conducted at Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India from February 2023 to September 2025. A total of 100 hypertensive patients were recruited using a purposive sampling method. Each participant underwent clinical assessment, Blood Pressure (BP) measurement, ECG, and (2D echo and doppler imaging). The prevalence and severity of DD were analysed, and its associations with age, duration of hypertension, severity of hypertension, and ECG findings were evaluated. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20, with a p-value <0.05 considered significant. Results: DD was detected in 46% of hypertensive patients, with 19% having grade 1 DD, 11% grade 2, and 16% grade 3. The prevalence of DD increased with age, from 25% in patients below 40 years to 62.5% in those aged 71-80 years. A significant association was found between hypertension duration and DD (p=0.023*), with 26.1% of patients with 1-5 years of hypertension exhibiting DD, increasing to 66.7% in those with more than 15 years. Among patients with grade 3 hypertension, 75% had DD confirming that worsening hypertension increases DD risk. On ECG analysis, 17% of patients had Left Ventricular Hypertrophy (LVH), and 70.6% of them had DD (p=0.026*), indicating a strong association between LVH and DD. Echocardiographic findings showed 46% had impaired LV relaxation, and 27% had elevated Left Atrial Pressure (LAP). Comparative analysis revealed that patients with DD had significantly higher mean age, longer hypertension duration, and higher Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (p <0.05), whereas Body Mass Index (BMI), Blood Sugar Levels (BSL), and lipid profiles did not show significant differences. Conclusion: The study found that DD is prevalent in nearly half of hypertensive patients, with its prevalence increasing with age, hypertension severity, and duration. Significant associations were observed between LVH on ECG and echocardiographic evidence of DD, reinforcing the need for early screening and stringent BP control to prevent progression to heart failure. Routine echocardiographic assessment of hypertensive patients should be emphasised to detect and manage DD at an early stage.