Effects of colchicine on cardiac structure and function in patients with hypertension: a prespecified secondary analysis of the COlchicine HypERtENsion Trial (COHERENT)

Background Hypertension is a common and important risk factor for cardiovascular (CV) disease. The immune system and inflammatory response contribute to the pathology of hypertension. Colchicine has shown promise in delaying the progression of manifest atherosclerotic disease. However, the effects of colchicine on cardiac structure and function in patients with hypertension without manifest CV disease have not been investigated. Methods COHERENT was a 6-month investigator-initiated, prospective, randomized, double-blind, placebo-controlled study of the effects of colchicine in adults with well-controlled hypertension without other known CV disease. Eligible patients were randomized 1:1 to colchicine 0.5 mg daily or placebo. Echocardiography and biomarker assessment were performed at baseline and 6 months. Prespecified exploratory endpoints included changes in echocardiographic measures of cardiac structure and function and biomarkers to determine the potential anti-inflammatory end-organ effect of colchicine. Results Of 187 screened, 150 participants were randomized. Baseline characteristics are available in Table 1. No observable differences in echocardiographic measurements were found between the colchicine group and the placebo group after 6 months of treatment, except for a decrease of tricuspid annular plane systolic excursion (TAPSE) in the colchicine group (TAPSE, -0.26 cm [95% CI: -0.40 to -0.11]; p<0.001) (Table 2). Left ventricular systolic and diastolic function did not change. Leukocyte count decreased significantly in the colchicine group compared with the placebo group after 6 months treatment (between-group difference in % change in leukocyte count, -8.0% [95% CI: -13.5 to -2.5]; p=0.004). There was no observable change between groups in NT-proBNP or eGFR at 6 months treatment (Table 2). Conclusion In COHERENT, the first trial to investigate the effects of colchicine on echocardiographic and biochemical measurements in patients with hypertension without other known CV disease, colchicine had no observable impact on echocardiographic measurements of left ventricular systolic or diastolic function after 6 months of treatment. While a change in TAPSE was observed between groups, the absolute values remained within the normal clinical range, and no corresponding changes were seen in other right heart parameters. Consequently, our findings suggest that short-term colchicine does not induce significant structural or functional remodeling in this hypertensive population but is safe and confers an anti-inflammatory effect. Further research is warranted to determine if these results persist in higher-risk cohorts or with longer treatment duration.