Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency

Carolyn S.P. Lam, Amil M. Shah, Barry A. Borlaug, Susan Cheng, Anil Verma, Joseph Izzo, Suzanne Oparil, Gerard P. Aurigemma, James D. Thomas, Bertram Pitt, Michael R. Zile, Scott D. Solomon

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

AimsTo investigate the effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency in early-stage hypertension.Methods and resultsWe studied 527 participants from two clinical trials assessing the effect of blood pressure lowering on diastolic function. Participants were aged ≥45 years with early-stage hypertension, no heart failure, ejection fraction (EF) ≥50%, and diastolic dysfunction using Doppler echocardiography. Effective arterial afterload and its components were assessed along with measures of left ventricular (LV) structure and function prior to and after 24-38 weeks of antihypertensive therapy. Systolic blood pressure decreased from 154 ± 18 to 137 ± 15 mmHg at follow-up. Blood pressure reduction was associated with decreases in ventricular and arterial stiffness, improvements in systemic arterial compliance and resistance, enhanced LV ejection, and reduction in cardiac work (all P < 0.001). Changes in Ea/Ees ratio were inversely correlated with those in EF (r = -0.25; P < 0.001), stroke work index (r = -0.13; P = 0.007), and LV efficiency (r = -0.98; P < 0.001); and directly related to changes in mitral E/e′ (r = 0.12; P = 0.01). Adjusting for age and blood pressure change, women and obese individuals had less enhancement in ventricular-arterial coupling and efficiency compared with men and non-obese individuals (P = 0.04 and 0.007, respectively).ConclusionAntihypertensive therapy reduces arterial and ventricular stiffness, enhances ventricular-arterial coupling, reduces cardiac work, and improves LV efficiency, systolic, and diastolic function. Attenuated responses in women and among obese subjects suggest that structure-function changes may be less reversible in these groups, possibly explaining their greater susceptibility to ultimately develop heart failure.

Original languageEnglish (US)
Pages (from-to)676-683
Number of pages8
JournalEuropean heart journal
Volume34
Issue number9
DOIs
StatePublished - Mar 1 2013

Keywords

  • Arterial stiffness
  • Echocardiography
  • Hypertension
  • Ventricular stiffness

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lam, C. S. P., Shah, A. M., Borlaug, B. A., Cheng, S., Verma, A., Izzo, J., Oparil, S., Aurigemma, G. P., Thomas, J. D., Pitt, B., Zile, M. R., & Solomon, S. D. (2013). Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency. European heart journal, 34(9), 676-683. https://doi.org/10.1093/eurheartj/ehs299