Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study
dc.contributor.author | Jordan, AN | |
dc.contributor.author | Fulford, J | |
dc.contributor.author | Gooding, K | |
dc.contributor.author | Anning, C | |
dc.contributor.author | Wilkes, L | |
dc.contributor.author | Ball, C | |
dc.contributor.author | Pamphilon, N | |
dc.contributor.author | Mawson, D | |
dc.contributor.author | Clark, CE | |
dc.contributor.author | Shore, AC | |
dc.contributor.author | Sharp, ASP | |
dc.contributor.author | Bellenger, NG | |
dc.date.accessioned | 2021-10-29T08:14:44Z | |
dc.date.issued | 2021-10-25 | |
dc.description.abstract | 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). | en_GB |
dc.description.sponsorship | National Institute for Health Research | en_GB |
dc.description.sponsorship | Gawthorn Cardiac Trust | en_GB |
dc.identifier.citation | Vol. 23, article 122 | en_GB |
dc.identifier.doi | 10.1186/s12968-021-00805-5 | |
dc.identifier.uri | http://hdl.handle.net/10871/127629 | |
dc.language.iso | en | en_GB |
dc.publisher | BMC/Society for Cardiovascular Magnetic Resonance | en_GB |
dc.rights | © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. | en_GB |
dc.subject | Left ventricular hypertrophy | en_GB |
dc.subject | Feature tracking | en_GB |
dc.subject | Strain | en_GB |
dc.subject | Torsion | en_GB |
dc.subject | Rapid treatment | en_GB |
dc.subject | Hypertension | en_GB |
dc.title | Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2021-10-29T08:14:44Z | |
dc.identifier.issn | 1097-6647 | |
exeter.article-number | 122 | en_GB |
dc.description | This is the final version. Available from BMC via the DOI in this record. | en_GB |
dc.description | Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. | en_GB |
dc.identifier.eissn | 1532-429X | |
dc.identifier.journal | Journal of Cardiovascular Magnetic Resonance | en_GB |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2021-08-12 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-10-25 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2021-10-29T08:11:25Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2021-10-29T08:14:53Z | |
refterms.panel | A | en_GB |
Files in this item
This item appears in the following Collection(s)
Except where otherwise noted, this item's licence is described as © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.