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
Clinical Trial
. 2024 Mar;12(3):567-579.
doi: 10.1016/j.jchf.2023.07.030. Epub 2023 Oct 18.

Mavacamten for Obstructive Hypertrophic Cardiomyopathy With or Without Hypertension: Post-Hoc Analysis of the EXPLORER-HCM Trial

Andrew Wang  1 , John A Spertus  2 , Daniel M Wojdyla  3 , Theodore P Abraham  4 , Ester Kim Nilles  3 , Anjali Tiku Owens  5 , Sara Saberi  6 , Sharon Cresci  7 , Amy Sehnert  8 , Neal K Lakdawala  9
Affiliations
Free article
Clinical Trial

Mavacamten for Obstructive Hypertrophic Cardiomyopathy With or Without Hypertension: Post-Hoc Analysis of the EXPLORER-HCM Trial

Andrew Wang et al. JACC Heart Fail. 2024 Mar.
Free article

Abstract

Background: Hypertension (HTN) is common in patients with hypertrophic cardiomyopathy (HCM), but its effect on the treatment of left ventricular outflow tract (LVOT) obstruction is undefined. Although elevated systolic blood pressure (SBP) may impact dynamic LVOT gradients, its response to cardiac myosin inhibition is unknown.

Objectives: In a post hoc exploratory analysis of the EXPLORER-HCM trial (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy), the authors examined the characteristics of patients with obstructive HCM and HTN and the associations between HTN, SBP, and the response to mavacamten treatment of LVOT obstruction.

Methods: Patients were stratified by baseline history of HTN and mean SBP during 30-week treatment with mavacamten or placebo. The study estimated treatment differences and evaluated HTN and SBP groups by treatment interaction. Analysis of covariance was used to model changes in continuous endpoints, and a generalized linear model was used for binary endpoints.

Results: HTN was present in 119 of 251 patients (47.4%), including 60 receiving mavacamten and 59 receiving placebo. Patients with HTN vs no HTN were older (63.4 vs 54.0 years; P < 0.001), had higher SBP (134 ± 15.1 mm Hg vs 123 ± 13.8 mm Hg; P < 0.001), more comorbidities, and lower peak oxygen consumption (19 ± 3 vs 20 ± 4 mL/kg/min; P = 0.021). Patients with HTN had similar NYHA functional class (NYHA functional class II, 72% vs 73%), Valsalva LVOT gradients (72 ± 34 mm Hg vs 74 ± 30 mm Hg), Kansas City Cardiomyopathy Questionnaire-Clinical Summary Scores (70.6 ± 18.8 vs 68.9 ± 23.1), and NT pro-B-type natriuretic peptide levels (geometric mean 632 ± 129 pg/mL vs 745 ± 130 pg/mL). Mavacamten-treated patients had improvement in all primary, secondary, and exploratory endpoints regardless of HTN status or mean SBP.

Conclusions: The clinical benefits of mavacamten in symptomatic, obstructive HCM were similar in patients with and without HTN, despite differences in baseline characteristics. (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy [EXPLORER-HCM]; NCT03470545).

Keywords: hypertension; hypertrophic cardiomyopathy; mavacamten; myosin inhibitor; obstruction.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, provided funding for statistical analyses. Dr Wang has been a consultant and/or served on advisory boards for BMS, Cytokinetics, and Biomarin; has served on the Speakers Bureau for BMS; and has received research grants from BMS and Cytokinetics. Dr Spertus has been a consultant for Alnylam, AstraZeneca, Bayer, Merck, Janssen, BMS, Edwards, Kineksia, 4DT Medical, Terumo, Cytokinetics, Imbria, and United Healthcare; has received research grants from BMS, Abbott Vascular, and Janssen; holds the copyrights to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Peripheral Artery Questionnaire; and has served on the board of directors for Blue Cross Blue Shield of Kansas City. Dr Owens has been a consultant and/or served on advisory boards for BMS, Cytokinetics, Pfizer, Renovacor, Edgewise, Tenaya, and Lexicon. Dr Saberi has been the site principal investigator for trials for BMS, Cytokinetics, and Novartis; has served on steering committees for trials for BMS and Cytokinetics; and has received consulting/honoraria from BMS and Cytokinetics. Dr Sehnert is an employee of Bristol Myers Squibb. Dr Lakdawala has been a consultant for BMS, Pfizer, Cytokinetics, and Tenaya; and has received research support from Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publication types

MeSH terms

Associated data