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Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular
Wojciech Kosmala1, Thomas H Marwick2, Tony Stanton3
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Wroclaw Medical University, Wroclaw, Poland;
Insights
Central blood pressure (BP)-guided hypertension management, even with medication reduction, did not negatively impact left ventricular (LV) systolic or diastolic function. This approach ensures safe and effective BP control without compromising heart function.
Area of Science:
- Cardiology
- Hypertension Management
- Echocardiography
Background:
- Central blood pressure (BP) is crucial for end-organ damage and prognosis in hypertension.
- Previous studies showed no adverse effects on left ventricular (LV) structure with central BP-guided management.
- The impact on LV function, however, remained uninvestigated.
Purpose of the Study:
- To investigate the effect of central BP-guided hypertension management on LV systolic and diastolic performance.
- To compare LV function between usual care and central BP-guided intervention groups.
Main Methods:
- 286 participants with uncomplicated hypertension were randomized to usual care (UC) or central BP intervention (CBP).
- Therapeutic decisions were guided by central BP measurements in the CBP group.
- 2D echocardiography was performed at baseline and 12 months, with blinded assessment.
Main Results:
- Antihypertensive medication decreased significantly in the CBP group but not UC.
- No significant differences were observed in brachial or central BP, augmentation index, or augmented pressure between groups.
- LV diastolic function (e' velocity, E/e' ratio) and systolic function (longitudinal strain, circumferential strain, ejection fraction) showed no between-group differences.
Conclusions:
- Central BP-guided hypertension management, even with medication withdrawal, has no adverse effects on LV systolic or diastolic function.
- This management strategy is safe for maintaining cardiac function in hypertensive patients.
Background:
Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance.
Methods:
A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation.
Results:
Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (∆UC vs. ∆CBP; P = 0.27) and E/e' ratio (∆UC vs. ∆CBP; P = 0.60), and systolic parameters: LV longitudinal strain (∆UC vs. ∆CBP; P = 0.55), circumferential strain (∆UC vs. ∆CBP; P = 0.79), and ejection fraction (∆UC vs. ∆CBP; P = 0.15).
Conclusions:
Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. Clinical trials registration: Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358.
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