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Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension

Yoo, Jeung-Ki, PhD1,2; Okada, Yoshiyuki, PhD1,2; Best, Stuart, A., PhD1,2; Parker, Rosemary, S., MS1; Hieda, Michinari, MD1,2; Levine, Benjamin, D., MD1,2; Fu, Qi, MD, PhD1,2

doi: 10.1097/GME.0000000000001046
Original Articles
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Objective: The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood.

Methods: Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry.

Results: Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m2), but it was lower in the normotensive group (41.7 ± 0.9 g/m2; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyn*s/cm5), whereas controlled HTN group (1925 ± 527 dyn*s/cm5) was not different to either groups.

Conclusion: Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.

1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX

2The University of Texas Southwestern Medical Center, Dallas, TX.

Address correspondence to: Qi Fu, MD, PhD, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231-8205. E-mail: FuQi@texashealth.org

Received 14 August, 2017

Revised 7 November, 2017

Accepted 7 November, 2017

Funding/support: Supported by NIH R01 HL091078 grant.

Financial disclosure/conflicts of interest: None reported.

© 2018 by The North American Menopause Society.