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Blood pressure categorization and subclinical left ventricular dysfunction in antihypertensive medication-naive

Koki Nakanishi1, Masao Daimon1,2, Yuriko Yoshida1,3

  • 1Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

ESC Heart Failure
|February 24, 2022
PubMed

Insights

New blood pressure categories are linked to early heart muscle changes, especially in women. Isolated diastolic hypertension and systolic hypertension significantly increase the risk of impaired left ventricular global longitudinal strain.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Hypertension Research

Background:

  • Subclinical left ventricular (LV) dysfunction is a precursor to heart failure.
  • The impact of new blood pressure (BP) categories on LV dysfunction requires clarification.
  • Sex-specific differences in BP-related cardiac changes are not well understood.

Purpose of the Study:

  • To investigate the relationship between the 2017 ACC/AHA BP categories and subclinical LV dysfunction.
  • To explore potential sex-specific differences in this relationship.

Main Methods:

  • Analysis of 858 individuals without cardiac disease, categorized by BP: normal, elevated, isolated diastolic hypertension (IDH), and systolic hypertension (SH).
  • Assessment of LV global longitudinal strain (LVGLS) and LV global circumferential strain (LVGCS) using 2D speckle-tracking echocardiography.
  • Multivariable and sex-stratified analyses to determine associations between BP categories and LV strain parameters.

Main Results:

  • Prevalence of abnormal LVGLS was significantly higher in SH (19.0%), IDH (17.5%), and elevated BP (14.2%) groups compared to normal BP (7.1%).
  • IDH and SH were independently associated with impaired LVGLS (OR 2.69 and 2.66, respectively).
  • Elevated BP showed a borderline association with impaired LVGLS (OR 1.90), significant only in women during sex-stratified analysis.

Conclusions:

  • The 2017 ACC/AHA guideline categories of IDH and SH are associated with impaired LVGLS.
  • Elevated BP is linked to LVGLS abnormalities, particularly in women.
  • These findings highlight the cardiac implications of newly defined BP categories and underscore sex-specific risks.
Abstract

Keywords:
Blood pressureLeft ventricular strainPrimary preventionSex differenceSpeckle-tracking echocardiography

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