Adverse cardiac remodeling is absent in patients with true controlled resistant hypertension

Author:

Matanes Faris123ORCID,Siddiqui Mohammed134ORCID,Velasco Alejandro5,Sharifov Oleg3,Kreps Eric3,Dudenbostel Tanja13,Judd Eric K134,Zhang Bin67,Lloyd Steven G138,Oparil Suzanne13,Calhoun David A13

Affiliation:

1. Vascular Biology and Hypertension Program University of Alabama at Birmingham Birmingham USA

2. Jordan University of Science and Technology Irbid Jordan

3. Department of Medicine University of Alabama at Birmingham Birmingham Alabama USA

4. Division of nephrology University of Alabama at Birmingham Birmingham USA

5. Cardiology Department Montefiore Medical Center Bronx New York USA

6. Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

7. Department of Pediatrics University of Cincinnati Cincinnati Ohio USA

8. VA Medical Center Birmingham Alabama USA

Abstract

AbstractResistant hypertension (RHTN), defined as blood pressure (BP) that is uncontrolled with ≥3 medications, including a long‐acting thiazide diuretic, also includes a subset with BP that is controlled with ≥4 medications, so‐called controlled RHTN. This resistance is attributed to intravascular volume excess. Patients with RHTN overall have a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction compared to patients with non‐RHTN. We tested the hypothesis that patients with controlled RHTN due to the intravascular volume excess have higher left ventricular mass index (LVMI), higher prevalence of LVH, larger intracardiac volumes, and more diastolic dysfunction compared to patients with controlled non‐resistant hypertension (CHTN), defined as BP controlled with ≤3 anti‐hypertensive medications. Patients with controlled RHTN (n = 69) or CHTN (n = 63) who were treated at the University of Alabama at Birmingham were offered enrollment and underwent cardiac magnetic resonance imaging. Diastolic function was assessed by peak filling rate, time needed in diastole to recover 80% of stroke volume, E:A ratios and left atrial volume. LVMI was higher in patients with controlled RHTN (64.4 ± 22.5 vs 56.9 ± 11.5; P = .017). Intracardiac volumes were similar in both groups. Diastolic function parameters were not significantly different between groups. There were no significant differences in age, gender, race, body mass index, dyslipidemia between the two groups. The findings show that patients with controlled RHTN have higher LVMI, but comparable diastolic function to those of patients with CHTN.

Funder

National Institutes of Health

Publisher

Wiley

Subject

Cardiology and Cardiovascular Medicine,Endocrinology, Diabetes and Metabolism,Internal Medicine

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