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Uncontrolled blood pressure as an independent risk factor of early impaired left ventricular systolic function in treated hypertension
Author(s) -
Chen XiaoJing,
Sun XiaoLin,
Zhang Qing,
Gao XiLian,
Liang YuJia,
Jiang Jing,
Kang Yu,
Chen YuCheng,
Zeng Zhi,
Yu CheukMan
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13289
Subject(s) - medicine , cardiology , ejection fraction , blood pressure , speckle tracking echocardiography , left ventricular hypertrophy , muscle hypertrophy , heart failure
Background Uncontrolled blood pressure ( BP ) is commonly observed in patients receiving antihypertensive agents. However, its relationship with early left ventricular ( LV ) dysfunction has not been elucidated. Methods This study enrolled 276 patients with treated hypertension and 85 healthy controls. The 140/90 mm Hg was used to define controlled ( HT 1 group, n=145) or uncontrolled BP ( HT 2 group, n=131) according to the concurrent guidelines. LV myocardial function was assessed by two‐dimensional speckle tracking imaging, and the circumferential end‐systolic wall stress ( cESS )‐corrected mid‐wall fraction shortening ( MWFS ), systolic longitudinal (εLs‐18), circumferential (εCs‐18), and radial (εRs‐18) strain were measured. Results Despite similar ejection fraction, the HT 1 and HT 2 groups displayed an overall reduction in the cESS ‐corrected MWFS (13.4±2.7 vs 11.7±1.7 vs 15.5±1.2), εLs‐18 (15.6±2.8 vs 13.0±2.2 vs 17.4±2.8), εCs‐18 (17.3±3.4 vs 14.1±2.7 vs 18.9±3.3), and εRs‐18 (18.4±4.0 vs 14.8±3.1 vs 20.5±4.5) %·cm 2 /kdyne·10 −2 when compared with the control group (all P <.001). The changes were more obvious in the HT 2 group, regardless of LV hypertrophy. Reductions in the cESS ‐corrected MWFS and εLs‐18 were seen in 68 (25%) and 52 (19%) patients, respectively. Uncontrolled BP were 4.365 times (95% CI 2.203–8.648, P <.001) and 3.928 times (1.851–8.337, P <.001) more likely to be associated with the changes. Conclusions Uncontrolled BP in hypertensive patients is associated with further reduction in LV myocardial function detected by advanced echocardiographic techniques, which cannot be explained by the increase in afterload. It might be regarded as a composite risk factor for earlier and faster development of clinical heart failure, therefore, a simplified treatment target.