Yang Yan, Li Yan, Zhu Limin, Xu Jianzhong, Tang Xiaofeng, Gao Pingjin
Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Laboratory of Vascular Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
Front Cardiovasc Med. 2023 Jul 26;10:1161993. doi: 10.3389/fcvm.2023.1161993. eCollection 2023.
The impact of blood pressure (BP) control and its timing on left ventricular (LV) structure and function remains unclear. The present study was to evaluate whether BP control correlated with conventional LV geometry and function indexes or global longitudinal strain (GLS) progression, and when echocardiographic changes would occur in essential hypertension.
A total of 62 participants (mean age 55.2 ± 11.5, male 71.0%) with uncontrolled hypertension were enrolled in the longitudinal study. Patients were followed up at the 6-month and 18-month, when echocardiographic measurements were performed and BP control was evaluated during the follow up period. At the 6- and 18-month examination, we divided the hypertensive patients into two groups as BP controlled and uncontrolled group. Patients with BP uncontrolled ( = 33) had higher LV mass index ( = 0.02), higher left atrial volume index ( = 0.01), worse GLS ( = 0.005) and GLS changes ( = 0.003) compared with controlled BP ( = 29) at the 6-month follow-up examination. Patients with uncontrolled BP ( = 25) had higher LV mass index ( = 0.001), higher LV mass index changes ( = 0.01), higher relative wall thickness ( = 0.01), higher /' ( = 0.046), worse GLS ( = 0.02) and GLS changes ( = 0.02) compared to BP controlled group ( = 24) at the 18-month follow-up examination. GLS changes were associated with BP control (= 0.370, = 0.004 at the 6-month examination and = 0.324, = 0.02 at the 18-month examination, respectively) in stepwise multivariate regression analysis. LV mass index changes was corelated with systolic BP (= 0.426, = 0.003) at the 18-month follow-up examination in stepwise multivariate regression analysis. Neither was GLS changes nor LV mass index changes were related to antihypertensive medication class, including combination therapy in 6- or 18-month follow up examination.
Our findings offer new clinical evidence on the association of BP control with echocardiographic changes in hypertensive patients, and, in particular, support the view that GLS progression was earlier and subtler than conventional LV geometry and function parameters. GLS changes were significant between BP controlled and uncontrolled patients even in 6-month follow-up period.
血压（BP）控制及其时机对左心室（LV）结构和功能的影响仍不明确。本研究旨在评估血压控制是否与传统的左心室几何形状和功能指标或整体纵向应变（GLS）进展相关，以及在原发性高血压患者中何时会出现超声心动图变化。
共有62例未控制高血压的参与者（平均年龄55.2±11.5岁，男性占71.0%）纳入纵向研究。在6个月和18个月时对患者进行随访，期间进行超声心动图测量并评估血压控制情况。在6个月和18个月检查时，我们将高血压患者分为血压控制组和未控制组。在6个月随访检查时，血压未控制的患者（n = 33）与血压控制的患者（n = 29）相比，左心室质量指数更高（P = 0.02），左心房容积指数更高（P = 0.01），GLS更差（P = 0.005）且GLS变化更大（P = 0.003）。在18个月随访检查时，血压未控制的患者（n = 25）与血压控制组（n = 24）相比，左心室质量指数更高（P = 0.001），左心室质量指数变化更大（P = 0.01），相对壁厚更高（P = 0.01），E/A更高（P = 0.046），GLS更差（P = 0.02）且GLS变化更大（P = 0.02）。在逐步多变量回归分析中，GLS变化与血压控制相关（6个月检查时r = 0.370，P = 0.004；18个月检查时r = 0.324，P = 0.02）。在18个月随访检查的逐步多变量回归分析中，左心室质量指数变化与收缩压相关（r = 0.426，P = 0.003）。在6个月或18个月随访检查中，GLS变化和左心室质量指数变化均与抗高血压药物类别无关，包括联合治疗。
我们的研究结果为血压控制与高血压患者超声心动图变化之间的关联提供了新的临床证据，特别是支持了GLS进展比传统左心室几何形状和功能参数更早、更细微的观点。即使在6个月随访期内，血压控制和未控制的患者之间GLS变化也很显著。
