Hypertension and myocardial fibrosis: A systematic review and meta-analysis

Hypertension (HTN) is a major risk factor for myocardial fibrosis (MF), a key contributor to cardiac dysfunction. This meta-analysis aims to evaluate the relationship between HTN and MF using data from imaging and histological studies.

This study was searched EMBASE, PubMed, Cochrane Library, and Google Scholar to identify observational and interventional studies evaluating the association between HTN, blood pressure (BP), and antihypertensive medications with MF, assessed by histology or cardiac magnetic resonance imaging (T1 mapping parameters: extracellular volume fraction [ECV%] and native T1 values).

A total of 39 studies comprising 45,776 participants were included in the analysis. The meta-analysis showed that HTN was significantly related to MF indicators, including collagen volume fraction (weighted mean difference [WMD]: 4.66; 95% confidence interval [CI]: 2.57 to 6.75), native T1 values (WMD: 38.34; 95% CI: 16.30 to 60.37), and ECV% (WMD: 1.89; 95% CI: 0.66 to 3.12). Higher MF levels correlated with left ventricular hypertrophy, heart failure, and elevated BP. Losartan, ramipril, and perindopril help control BP and attenuate MF, while amlodipine and hydrochlorothiazide do not statistically significantly alleviate MF.

The extent of MF is closely associated with various factors, underscoring the importance of its identification in hypertensive patients. Histology and T1 mapping parameters are effective for quantifying MF. Due to the variable effects of antihypertensive medications on MF, the use of specific agents to mitigate MF in hypertensive patients is recommended.