Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 25;23(1):122.
doi: 10.1186/s12968-021-00805-5.

Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study

Andrew N Jordan  1   2   3 , Jon Fulford  4   5 , Kim Gooding  4   5 , Christine Anning  4 , Lindsay Wilkes  4 , Claire Ball  4 , Nicola Pamphilon  4 , David Mawson  4 , Christopher E Clark  6 , Angela C Shore  4   5 , Andrew S P Sharp  5   7 , Nicholas G Bellenger  5   7
Affiliations

Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study

Andrew N Jordan et al. J Cardiovasc Magn Reson. .

Abstract

Background: Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis.

Methods: We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment.

Results: We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (- 20.8 ± 4.9 to - 19.1 ± 3.7, p = 0.02), apical circumferential strain (- 26.0 ± 5.3 to - 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003).

Conclusions: LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes.

Trial registration: ISRCTN registry number: 57475376 (assigned 25/06/2015).

Keywords: Feature tracking; Hypertension; Left ventricular hypertrophy; Rapid treatment; Strain; Torsion.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of strain parameters in relation to the LV myocardium
Fig. 2
Fig. 2
Number of enrolled participants in the clinical study of rapid hypertension treatment with MR imaging appropriate for analysis
Fig. 3
Fig. 3
Left ventricular (LV) mass (A) and mass index (B) before and after 18 weeks’ antihypertensive treatment
Fig. 4
Fig. 4
Radial strain (measured in the short axis) (A), mid-circumferential strain (B), apical circumferential strain (C) and apical rotation (D) before and after 18 weeks of antihypertensive treatment
See this image and copyright information in PMC

References

    1. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561–1566. doi: 10.1056/NEJM199005313222203. - DOI - PubMed
    1. Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS. The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med. 1992;117(10):831–836. doi: 10.7326/0003-4819-117-10-831. - DOI - PubMed
    1. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114(5):345–352. doi: 10.7326/0003-4819-114-5-345. - DOI - PubMed
    1. Muiesan ML, Salvetti M, Rizzoni D, Castellano M, Donato F, Agabiti-Rosei E. Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens. 1995;13(10):1091–1095. doi: 10.1097/00004872-199510000-00003. - DOI - PubMed
    1. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, et al. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation. 1998;97(1):48–54. doi: 10.1161/01.CIR.97.1.48. - DOI - PubMed

Publication types

MeSH terms

Associated data

LinkOut - more resources