A comprehensive assessment of cardiac structure and function in patients with treated malignant phase hypertension: The West Birmingham Malignant Hypertension project

• Published in: International journal of cardiology 2013-07, Vol.167 (1), p.67-72
• Main Authors: Shantsila, Alena, Dwivedi, Girish, Shantsila, Eduard, Butt, Mehmood, Beevers, D. Gareth, Lip, Gregory Y.H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Cross-Sectional Studies; Echocardiography, Doppler - methods; Echocardiography, Three-Dimensional - methods; England - epidemiology; Female; Follow-Up Studies; Heart; Humans; Hypertension, Malignant - diagnostic imaging; Hypertension, Malignant - epidemiology; Hypertension, Malignant - physiopathology; Investigative techniques, diagnostic techniques (general aspects); Left ventricular function; Male; Malignant hypertension; Medical sciences; Middle Aged; Three-dimensional echocardiography; Tissue Doppler imaging; Ultrasonic investigative techniques; Ventricular Function, Left - physiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.11.077

Abstract Background Previous studies have confirmed that cardiac structural and functional abnormalities exist in patients with malignant hypertension (MHT). The effect of long-term blood pressure control in MHT patients on cardiac structure and function is still unknown. Methods We performed detailed left ventricle (LV) assessment using two-dimensional (2DE) and three-dimensional (3DE) echocardiography, and tissue Doppler imaging (TDI) in patients with previous MHT (but now in stable phase) who were compared with patients with treated ‘high risk’ hypertension (HHT, but non-MHT) and healthy controls (HC). Vasodilator stress myocardial contrast echocardiography (in addition to wall motion analysis) was used to exclude significant coronary artery disease, as part of our comprehensive echocardiographic assessment. Septal and posterior wall thickness, LV mass index, LV volumes and ejection fraction, mitral valve inflow indices (E, A) mitral annular velocity (S, E′) and left atrial volume index (LAVI), were calculated using 2DE, 3DE, and TDI. MHT patients had good blood pressure control for an average of 144 months. Results A total of 95 subjects (MHT = 15; HHT and HC = 40 each) were studied. Both posterior and septal wall thickness were significantly higher in the MHT and hypertensive groups compared to normal controls with no difference between MHT and HHT. No significant difference in LV ejection fraction was found between the 3 groups. Increased LAVI (p < 0.05 MHT vs. HC and HHT vs. HC), reduced ‘S’ velocity on TDI (p = 0.05 MHT vs. HC and vs.HHT, p < 0.001 HHT vs. HC) and higher E/E′ (p = 0.029 HHT vs. HC) and lower E/A ratio (p = 0.001 MHT vs. HC, p < 0.001 HHT vs. HC) values were detected in the two hypertensive groups. Conclusion Despite long-term good blood pressure control, MHT patients have persistent structural and functional changes in LV function on echocardiography, comparable to that seen in HHT.