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Published on: August 8, 2022
Coexistence of Hypertrophic Cardiomyopathy and Arterial Hypertension: Current Insights and Future Directions
Vasiliki Katsi1, Konstantia Papadomarkaki1, Konstantinos Manousiadis2
1First Cardiology Department, Hippokration General Hospital of Athens, 11527 Athens, Greece.
Insights
Hypertrophic cardiomyopathy (HCM) and hypertension frequently coexist. Managing both conditions is complex, requiring careful drug selection to avoid worsening obstruction and improve patient outcomes.
Area of Science:
- Cardiology
- Genetics
- Pharmacology
Background:
- Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease.
- Arterial hypertension is a leading global cardiovascular risk factor.
- Coexistence of HCM and hypertension affects 40-60% of adults with HCM, with understudied implications.
Purpose of the Study:
- To review the clinical profile and management of patients with concomitant HCM and hypertension.
- To emphasize pharmacologic treatment and emerging therapies for this population.
Main Methods:
- Narrative review of existing literature.
- Focus on clinical presentation and therapeutic strategies.
- Evaluation of pharmacologic interventions and novel agents.
Main Results:
- Patients with both conditions are older, have more comorbidities, and greater functional limitation.
- Hypertension can complicate diagnosis and is associated with higher rates of atrial fibrillation and stroke.
- Management is challenging due to potential exacerbation of left ventricular outflow tract obstruction by vasodilators; beta-blockers and non-dihydropyridine calcium channel blockers are preferred.
Conclusions:
- The overlap of HCM and hypertension requires further investigation.
- Optimizing diagnosis and treatment strategies is crucial for improving patient outcomes.
Background:
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. Arterial hypertension represents the leading modifiable risk factor for cardiovascular morbidity and mortality globally. Their coexistence is frequent, affecting approximately 40-60% of adults with HCM, yet the implications of this overlap remain insufficiently investigated.
Methods:
We conducted a narrative review of the existing literature addressing the clinical profile and management strategies in patients with concomitant HCM and hypertension. Particular emphasis was placed on pharmacologic treatment and the role of emerging therapies for this population.
Results:
Patients with both conditions are generally older, with more cardiometabolic comorbidities and greater functional limitation than those with isolated HCM. Hypertension may confound diagnosis and is linked to a higher prevalence of atrial fibrillation and stroke. Its effect on ventricular arrhythmias, sudden cardiac death and mortality is less clear. Management is challenging, as vasodilatory antihypertensives can exacerbate left ventricular outflow tract obstruction. β-blockers and non-dihydropyridine calcium channel blockers are preferred, while novel agents such as myosin inhibitors and SGLT2 inhibitors show potential but require further study.
Conclusions:
The coexistence of HCM and hypertension is frequent but insufficiently studied, with major implications for diagnosis and treatment. Further research is essential to optimize management and outcomes.
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