Abstract 14994: Reversibility of Contractile Dysfunction in Patients with Hypertensive Heart Disease
Background: Hypertension is frequently associated with the presence of diastolic dysfunction, which may be ameliorated by anti-hypertensive treatment. Prior studies suggest that hypertension is also associated with contractile dysfunction, even in the presence of a normal EF; whether or not such contractile dysfunction may also respond to blood pressure lowering therapy is not known.
Methods: We studied a subset of 84 patients with normal EF from the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction (EXCEED) trial who underwent 24 weeks of intensive vs. standard anti-hypertensive therapy with valsartan plus amlodipine (titrated to a goal SBP <135 versus <140 mmHg) and had both baseline and follow-up echocardiography with digital images readily available for strain analyses. We examined changes in contractile function, as reflected by global longitudinal systolic strain, in the entire cohort and in the subset of patients identified as having contractile dysfunction at baseline (defined as longitudinal strain >-15%).
Results: Systolic contractile function significantly improved in response to anti-hypertensive therapy (-18.0±0.4% to -19.0±0.4%, P=0.013; Figure), and this improvement correlated with increase in mitral annular relaxation velocity E' (r=-0.28, P=0.011) and decrease in LV mass (r=0.27, P=0.014). Improvement in systolic contractile function was particularly evident in the subset of patients (20%) who had baseline measures consistent with frank contractile dysfunction: -13.3±0.3% to -16.8±0.7%, P<0.0001 (Figure).
Conclusions: In patients with hypertensive heart disease and normal EF, systolic contractile function can be improved in the setting of targeted anti-hypertensive treatment, especially in patients with evidence of contractile dysfunction at baseline.
- © 2011 by American Heart Association, Inc.