What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=170). Intervention: Hypertension vs. Non-hypertensive. Primary outcome: Echocardiographic parameters at baseline and at follow-up.

July 9, 2018

The effect of hypertension on cardiac structure and function in different types of hypertrophic cardiomyopathy: A single-center retrospective study

Key Result

Hypertension decreased end-diastolic volume in obstructive HCM (p=0.045) and increased it in apical HCM (p=0.016), with no significant effect on left ventricular cavity size in septal HCM.

Study Design

Type

Cohort (n=170)

Multicenter

Structured PICO

Does hypertension affect cardiac structure and function in different types of hypertrophic cardiomyopathy?

Population

170 patients with hypertrophic cardiomyopathy (obstructive n=40, septal n=88, apical n=42)

Intervention

Hypertension

Comparator

Non-hypertensive patients with the same type of hypertrophic cardiomyopathy

Outcome

Echocardiographic parameters at baseline and follow-up (end-diastolic volume, left ventricular end-diastolic diameter, maximum aortic velocity, aortic maximum pressure gradient)surrogate

Hypertension differentially affects left ventricular capacity depending on the morphological subtype of hypertrophic cardiomyopathy, decreasing it in obstructive HCM and increasing it in apical HCM.

Abstract

OBJECTIVES: To determine whether hypertension (HTN) affects cardiac structure and function in different types of hypertrophic cardiomyopathy (HCM). DESIGN: Patients with obstructive HCM (n = 40), septal HCM (n = 88), and apical HCM (n = 42) were separated into hypertensive and non-hypertensive subgroups, and echocardiographic parameters at baseline and at follow-up were compared between the subgroups. RESULTS: At follow-up, hypertensive obstructive HCM patients showed a decrease in end-diastolic volume (from 93.87 ± 26.08 mL to 79.06 ± 20.07 mL; p= 0.045) and in left ventricular end-diastolic diameter (from 45.00 ± 5.32 mm to 41.83 ± 4.58 mm; p =0.042). Non-hypertensive obstructive HCM patients showed a decrease in maximum aortic velocity (from 2.01 ± 0.53 m/s to 1.28 ± 0.25 m/s; p= 0.011) and in aortic maximum pressure gradient (from 17.22 ± 9.57 mm Hg to 6.79 ± 2.44 mm Hg; p= 0.03). Hypertensive apical HCM patients showed an increase in end-diastolic volume (from 95.28 ± 16.54 mL to 119.74 ± 25.19 mL; p= 0.016) and in left ventricular end-diastolic diameter (from 45.28 ± 3.36 mm to 50.20 ± 4.56 mm; p= 0.007). CONCLUSIONS: HTN can affect left ventricular capacity in obstructive HCM and apical HCM, causing a decrease in ventricular capacity in the former and increase in the latter; it has no significant effect on the size of the left ventricular cavity in septal HCM. HTN can lead to a poor therapeutic effect on aortic flow rate and pressure gradient in obstructive HCM patients.

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