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Uncontrolled blood pressure as an independent risk factor of early impaired left ventricular systolic function in
Xiao-Jing Chen1, Xiao-Lin Sun1, Qing Zhang1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Uncontrolled blood pressure (BP) in hypertensive patients significantly worsens left ventricular (LV) myocardial function, even without increased afterload. This indicates BP control is crucial for preventing heart failure progression.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hypertension Research
Background:
- Uncontrolled blood pressure (BP) is prevalent in patients on antihypertensive medication.
- The link between uncontrolled BP and early left ventricular (LV) dysfunction remains unclear.
Purpose of the Study:
- To investigate the association between uncontrolled BP and subclinical LV myocardial dysfunction.
- To assess LV myocardial function using advanced echocardiographic techniques in hypertensive patients.
Main Methods:
- Enrolled 276 treated hypertensive patients and 85 healthy controls.
- Defined controlled (HT1) and uncontrolled (HT2) BP using guidelines (140/90 mm Hg threshold).
- Assessed LV function via 2D speckle tracking imaging, measuring cESS-corrected MWFS and longitudinal, circumferential, and radial strain.
Main Results:
- Both controlled and uncontrolled hypertensive groups showed reduced LV function (MWFS, εLs-18, εCs-18, εRs-18) compared to controls (P<.001).
- LV dysfunction was more pronounced in the uncontrolled BP group (HT2), irrespective of LV hypertrophy.
- Uncontrolled BP was significantly associated with reduced cESS-corrected MWFS (4.365 times) and εLs-18 (3.928 times).
Conclusions:
- Uncontrolled BP is linked to further LV myocardial dysfunction, independent of afterload.
- This dysfunction may serve as an early risk factor for clinical heart failure development.
- Emphasizes the importance of strict BP control for cardiovascular health in hypertensive patients.
Background:
Uncontrolled blood pressure (BP) is commonly observed in patients receiving antihypertensive agents. However, its relationship with early left ventricular (LV) dysfunction has not been elucidated.
Methods:
This study enrolled 276 patients with treated hypertension and 85 healthy controls. The 140/90 mm Hg was used to define controlled (HT1 group, n=145) or uncontrolled BP (HT2 group, n=131) according to the concurrent guidelines. LV myocardial function was assessed by two-dimensional speckle tracking imaging, and the circumferential end-systolic wall stress (cESS)-corrected mid-wall fraction shortening (MWFS), systolic longitudinal (εLs-18), circumferential (εCs-18), and radial (εRs-18) strain were measured.
Results:
Despite similar ejection fraction, the HT1 and HT2 groups displayed an overall reduction in the cESS-corrected MWFS (13.4±2.7 vs 11.7±1.7 vs 15.5±1.2), εLs-18 (15.6±2.8 vs 13.0±2.2 vs 17.4±2.8), εCs-18 (17.3±3.4 vs 14.1±2.7 vs 18.9±3.3), and εRs-18 (18.4±4.0 vs 14.8±3.1 vs 20.5±4.5) %·cm2 /kdyne·10-2 when compared with the control group (all P<.001). The changes were more obvious in the HT2 group, regardless of LV hypertrophy. Reductions in the cESS-corrected MWFS and εLs-18 were seen in 68 (25%) and 52 (19%) patients, respectively. Uncontrolled BP were 4.365 times (95% CI 2.203-8.648, P<.001) and 3.928 times (1.851-8.337, P<.001) more likely to be associated with the changes.
Conclusions:
Uncontrolled BP in hypertensive patients is associated with further reduction in LV myocardial function detected by advanced echocardiographic techniques, which cannot be explained by the increase in afterload. It might be regarded as a composite risk factor for earlier and faster development of clinical heart failure, therefore, a simplified treatment target.
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