Key result
Elevated blood pressure and hypertension are linked to progressive adverse cardiac remodelling vs normal BP.
Why the study?
While hypertension is known to cause cardiac end-organ damage, the adverse cardiac effects of elevated blood pressure detected by imaging and circulating biomarkers are less well established.
Are elevated blood pressure and hypertension associated with adverse cardiac remodelling detected by echocardiography and circulating biomarkers compared to normal blood pressure in the general population?
Cohort (n=9,589)
Are elevated blood pressure and hypertension associated with adverse cardiac remodelling detected by echocardiography and circulating biomarkers compared to normal blood pressure in the general population?
Elevated blood pressure, as defined by the 2024 ESC guidelines, is already associated with subclinical adverse cardiac remodelling and diastolic dysfunction in the general population, with effects increasing further in overt hypertension.
Answers are grounded in this paper and cite their sources.
eBP and HTN link to subclinical remodelling in general populations; extends prior evidence to 2024 ESC categories but leaves causal effects and screening implications open.
Background/Introduction Hypertension (HTN) can cause end-organ damage to several organ systems, including the heart. The adverse cardiac effects of elevated blood pressure (eBP) are less well established. Purpose We aimed to understand the changes associated with eBP and HTN in a large-scale population-based cohort, detected by both imaging and circulating biomarkers. Methods Middle-aged adults from a population-based cohort study in Germany underwent standardized blood pressure measurements, in-depth transthoracic echocardiography and blood sampling. eBP and HTN were categorized according to the 2024 ESC guidelines. Linear regression models were performed, with standardized continuous dependent variables and multivariable adjustment for age, sex, smoking status, educational level, body mass index, logarithmic alcohol intake, heart rate, diabetes, total cholesterol, kidney disease, and a composite self-reported health status score derived from five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), treated as a continuous variable. Results In total n=9,589 participants were available for this analysis (median age 63 years, 51% women). In multivariable-adjusted linear regression models, normal blood pressure was used as the reference category. Both eBP and HTN were significantly associated with several cardiac and biomarker variables, with generally larger effect sizes for HTN compared with eBP: A-wave velocity (Standard coefficient [β] 0.14, p=0.005 for eBP and β 0.15, p=0.004 for HTN), mitral valve E/A (β -0.24 and β -0.35, respectively, p<0.001 for both), IVSd (β 0.16 and β 0.32, respectively, p<0.001 for both) and left ventricular posterior wall diameter (β 0.11, p=0.018 and β 0.30, P<0.001, respectively). Some variables were statistically significantly associated only with hypertension, but not with elevated blood pressure: Median E/E’ (mean of lateral and medial) (β 0.07, p=0.19 for eBP and β 0.23, p<0.001 for HTN), left ventricular mass (β 0.05, p=0.21 and β 0.19, p<0.001, respectively) and logarithmic high-sensitive Troponin I (β 0.06, p=0.16 and β 0.20, p<0.001, respectively). Conclusions Both eBP and HTN are associated with cardiac remodelling including left ventricular hypertrophy, right ventricular function, atrial dilatation and diastolic dysfunction. Most of these changes gradually increase in their effect size from elevated blood pressure to hypertension. We demonstrate the adverse effects of eBP on cardiac dimension and function in a comprehensive, multimodal assessment in the largest population-based cohort published to date. This highlights the relevance of eBP as a serious condition capable of causing adverse end-organ damage in the general population.
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Ohlrogge et al. (2026) conducted a cohort in Elevated blood pressure and hypertension (n=9,589). Elevated blood pressure (eBP) and hypertension (HTN) vs. Normal blood pressure was evaluated on Cardiac remodelling detected by echocardiographic variables (e.g., IVSd, mitral valve E/A, A-wave velocity, LVPWd) and circulating biomarkers (IVSd: β 0.16 (eBP), β 0.32 (HTN); Mitral E/A: β -0.24 (eBP), β -0.35 (HTN), p=<0.001). Elevated blood pressure and hypertension were significantly associated with adverse cardiac remodelling vs normal BP, including increased IVSd (β 0.16 and β 0.32, p<0.001) and lower E/A (p<0.001).
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