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Reversibility of left ventricular mechanical dysfunction in patients with hypertensive heart disease

Cheng, Susana; Shah, Amil M.a; Albisu, Juan Pabloa; Desai, Akshay S.a; Hilkert, Robert J.b; Izzo, Josephc; Oparil, Suzanned; Pitt, Bertrame; Solomon, Scott D.a

doi: 10.1097/HJH.0000000000000340

Objective: Prior studies indicate that hypertension is associated with mechanical systolic dysfunction, even in the presence of a normal ejection fraction, but whether this cardiac dysfunction may be ameliorated by antihypertensive treatment is unknown.

Methods: To test the hypothesis that mechanical systolic dysfunction in hypertension may respond to blood pressure-lowering therapy, we studied 182 patients with uncontrolled hypertension who underwent a 24-week trial of intensive versus standard antihypertensive therapy (titrated to a goal SBP <130 versus <140 mmHg) and had both baseline and follow-up echocardiography. We examined changes in left ventricular systolic function, reflected by systolic global longitudinal strain (GLS), in the entire cohort and in the subset of patients with systolic dysfunction at baseline (defined as GLS >−15%).

Results: Despite all patients having a preserved left ventricular ejection fraction (≥50%), almost a third (32%) had mechanical systolic dysfunction at baseline. In the total sample, GLS significantly improved in response to antihypertensive therapy (−16.8 ± 3.8 to −18.7 ± 3.4%; P < 0.0001), and this improvement was especially evident in patients with baseline dysfunction (13.1 ± 2.2 to −17.0 ± 2.9%; P < 0.0001). Improvement in GLS was associated with lower BMI (P = 0.015) and was greater in women than in men (P = 0.003). Although uncorrelated with blood pressure change, GLS improvement was related to having received high doses of antihypertensive therapy during the study (P = 0.040).

Conclusion: In patients with hypertensive heart disease and normal left ventricular ejection fraction, abnormalities in left ventricular mechanical systolic function can be ameliorated in the setting of targeted antihypertensive treatment.

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aFrom the Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts

bNovartis, East Hanover, New Jersey

cState University of New York at Buffalo, Buffalo, New York

dUniversity of Alabama, Birmingham, Alabama

eUniversity of Michigan, Ann Arbor, Michigan, USA

Correspondence to Susan Cheng, MD, Brigham and Women's Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA. Tel: +1 857 307 1988; fax: +1 857 307 1955; e-mail:

Abbreviations: AUC, area under the curve; GLS, global longitudinal strain; MAP, mean arterial pressure

Received 28 December, 2013

Revised 11 July, 2014

Accepted 11 July, 2014

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