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The long-term outcome of patients with hypertensive cardiomyopathy

C de Carvalho Frimm1, H N Soufen, M K Koike

  • 1Clínica Médica-Emergências Clínicas, Hospital das Clínicas-Faculdade de Medicina da USP, São Paulo, SP, Brazil. frimm@emercli.fm.usp.br

Journal of Human Hypertension
|February 18, 2005
PubMed

Insights

Hypertension-induced dilated cardiomyopathy (HT-DCM) carries a poor prognosis, with a 5-year mortality rate of 26%. Key predictors of mortality include advanced age and reduced left ventricular systolic function.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Heart Failure Studies

Background:

  • The long-term prognosis of dilated cardiomyopathy specifically caused by hypertension (HT-DCM) remains poorly understood, especially when other common conditions like coronary artery disease and diabetes are absent.
  • Left ventricular systolic dysfunction is a hallmark of HT-DCM, but its independent prognostic implications require further elucidation.

Purpose of the Study:

  • To investigate the long-term survival and identify mortality predictors in patients diagnosed with left ventricular systolic dysfunction solely due to hypertension.
  • To compare mortality rates between HT-DCM patients and a control group without significant left ventricular systolic dysfunction.

Main Methods:

  • A cohort of 90 patients with HT-DCM (echocardiographic fractional shortening [FS] < 30%) and 29 controls (FS ≥ 30%) were enrolled between October 1995 and May 2001.
  • Coronary artery disease was ruled out using myocardial perfusion imaging and, in a subset, coronary angiography.
  • Patients were followed for a mean of 4.3 years to assess mortality outcomes.

Main Results:

  • The overall mortality rate in the HT-DCM group was double that of the control group (P = 0.01), with a 5-year mortality rate of 26% for HT-DCM patients.
  • Univariate analysis indicated age and creatinine levels were positively associated with mortality, while body mass index, baseline FS, and follow-up blood pressure were negatively associated.
  • Multivariate analysis identified advanced age (HR 1.08), higher body mass index (HR 0.86), and lower baseline FS (HR 0.88) as independent predictors of mortality.

Conclusions:

  • The prognosis for patients with HT-DCM is significantly poorer than for those without, with a substantial 5-year mortality risk.
  • Mortality risk in HT-DCM is independently predicted by older age and the severity of left ventricular systolic dysfunction.
  • Conversely, higher blood pressure and body mass index during follow-up may indicate a more favorable prognosis, contrary to initial expectations.

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