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[Impact of blood pressure control on coronary flow reserve in hypertensive patients]
1Department of Cardiology, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Sciences, Beijing 100191, China.
Insights
Optimizing blood pressure in hypertensive patients is crucial for maintaining coronary flow reserve (CFR). Ideally controlled blood pressure ensures CFR levels comparable to those without hypertension, highlighting the importance of blood pressure management for cardiovascular health.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Echocardiography
Background:
- Hypertension is a significant risk factor for cardiovascular disease.
- Coronary flow reserve (CFR) is an important indicator of myocardial perfusion.
- The impact of blood pressure control on CFR in hypertensive patients requires further investigation.
Purpose of the Study:
- To assess the relationship between blood pressure control levels and CFR in hypertensive patients.
- To compare CFR among different blood pressure control categories in hypertension.
- To identify independent predictors of CFR in hypertensive individuals.
Main Methods:
- Retrospective analysis of 236 patients without significant coronary stenosis.
- Coronary flow reserve (CFR) measured using transthoracic Doppler echocardiography during hyperemia.
- Patients categorized into non-hypertension, ideally controlled hypertension, controlled hypertension, and uncontrolled hypertension groups.
Main Results:
- CFR was significantly lower in controlled and uncontrolled hypertension groups compared to non-hypertensive individuals.
- Ideally controlled hypertensive patients exhibited CFR levels similar to non-hypertensive individuals.
- Higher blood pressure and age were identified as independent predictors of reduced CFR in hypertensive patients.
Conclusions:
- Elevated blood pressure is an independent predictor of decreased CFR in hypertensive patients.
- Achieving ideal blood pressure control in hypertensive patients normalizes CFR to levels seen in non-hypertensive individuals.
- Effective blood pressure management is essential for preserving coronary microvascular function in hypertension.
Objective:
To investigate the impacts of blood pressure control on coronary flow reserve (CFR) in hypertensive patients.
Methods:
A total of 236 patients without significant coronary stenosis (defined as <50% luminal narrowing which was confirmed by coronary angiography or coronary artery CT scan) between January 2011 to July 2015 were retrospectively enrolled in this study. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by transthoracic Doppler echocardiography. Patients were divided into hypertension group (n=173) and non-hypertension group (n=63). The hypertension patients were further divided into ideally controlled (n=31, defined as SBP <120 mmHg (1 mmHg=0.133 kPa) and DBP <80 mmHg), controlled (n=82, defined as SBP 120 to 139 mmHg and DBP <90 mmHg) and uncontrolled groups (n=60, defined as SBP≥140 mmHg and/or diastolic DBP≥90 mmHg) based on their blood pressure after systematic antihypertensive therapy and CFR values were compared among the 4 groups. Multivariate regression analyses were performed to identify the independent determinants of CFR in patients with hypertension.
Results:
Compared with non-hypertension group, the CFR was significantly lower in controlled (3.27±0.71 vs. 2.87±0.56, P<0.001) and uncontrolled groups (3.27±0.71 vs. 2.61±0.71, P<0.001), but was similar in ideally controlled group (3.27±0.71 vs. 3.21±0.85, P=0.68). Furthermore, the CFR was significantly lower in uncontrolled group than that of the other two hypertension groups and was significantly lower in controlled group than that of ideally controlled group. Higher blood pressure (β=-0.17, P=0.03) and age(β=-0.02, P=0.03) were independent predictors of lower CFR in patients with hypertension.
Conclusions:
Higher blood pressure is an independent predictor of decreased CFR in patients with hypertension. Hypertensive patients with ideally controlled blood pressure have similar CFR level as patients without hypertension.
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