Ekström Mattias, Hellman Anna, Hasselström Jan, Hage Camilla, Kahan Thomas, Ugander Martin, Wallén Håkan, Persson Hans, Linde Cecilia
Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Solna, Sweden.
Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Solna, Sweden.
ESC Heart Fail. 2020 Apr;7(2):737-746. doi: 10.1002/ehf2.12612. Epub 2020 Feb 19.
Despite evidence-based therapeutic approaches, target blood pressure is obtained by less than half of patients with hypertension. Hypertension is associated with a significant risk for heart failure, in particular heart failure with preserved left ventricular (LV) ejection fraction (HFpEF). Although treatment is suggested to be given early after hypertension diagnosis, there is still no evidence-based medical treatment for HFpEF. We aim to study the underlying mechanisms behind the transition from uncomplicated hypertension to hypertensive heart disease (HHD) and HFpEF. To this end, we will combine cardiac imaging techniques and measurements of circulating fibrosis markers to longitudinally monitor fibrosis development in patients with hypertension.
In a prospective cohort study, 250 patients with primary hypertension and 60 healthy controls will be characterized at inclusion and after 1 and 6 years. Doppler echocardiography, cardiac magnetic resonance imaging, and electrocardiogram will be used for measures of cardiac structure and function over time. Blood biomarkers reflecting myocardial fibrosis, inflammation, and endothelial dysfunction will be analysed. As a proxy for HFpEF development, the primary endpoint is to measure echocardiographic changes in LV function and structure (E/e' and LAVI) and to relate these measures of LV filling to blood pressure, biomarkers, electrocardiogram, and cardiac magnetic resonance.
We aim to study the timeline and transition from uncomplicated hypertension to HHD and HFpEF. In order to identify subjects prone to develop HHD and HFpEF, we want to find biomarkers and cardiac imaging variables to explain disease progression. Ultimately, we aim at finding new pathways to prevent HFpEF.
尽管有循证治疗方法，但不到一半的高血压患者能达到目标血压。高血压与心力衰竭风险显著相关，尤其是射血分数保留的左心室（LV）心力衰竭（HFpEF）。尽管建议在高血压诊断后尽早进行治疗，但目前仍没有针对HFpEF的循证药物治疗方法。我们旨在研究从单纯高血压转变为高血压性心脏病（HHD）和HFpEF背后的潜在机制。为此，我们将结合心脏成像技术和循环纤维化标志物测量，对高血压患者的纤维化发展进行纵向监测。
在一项前瞻性队列研究中，250例原发性高血压患者和60例健康对照者将在纳入时、1年和6年后进行特征描述。随时间推移，将使用多普勒超声心动图、心脏磁共振成像和心电图来测量心脏结构和功能。将分析反映心肌纤维化、炎症和内皮功能障碍的血液生物标志物。作为HFpEF发展的替代指标，主要终点是测量左心室功能和结构的超声心动图变化（E/e'和LAVI），并将这些左心室充盈指标与血压、生物标志物、心电图和心脏磁共振相关联。
我们旨在研究从单纯高血压到HHD和HFpEF的时间线及转变过程。为了识别易发展为HHD和HFpEF的受试者，我们希望找到生物标志物和心脏成像变量来解释疾病进展。最终，我们旨在找到预防HFpEF的新途径。
