The impact of cardiovascular risk factors on longitudinal changes in cardiac structure and function in an older population of hypertensive patients

Abstract Background Hypertension is associated with cardiac structural and functional changes, with left ventricular hypertrophy and diastolic dysfunction as strong predictors of adverse cardiac events. Limited data exist on how cardiovascular (CV) risk factors accelerate left ventricular (LV) mass and diastolic dysfunction over time in older hypertensive patients. Purpose To investigate the association between CV risk factors and accelerated deterioration of LV mass, left atrial volume (LAV), global longitudinal strain (GLS), and tissue Doppler E/e’ ratio in an older population of hypertensive patients. Methods Post-hoc analysis of a randomized clinical trial that investigated whether atrial fibrillation screening, using an implantable loop recorder, and subsequent initiation of anticoagulation, could prevent stroke in high-risk individuals. Only individuals with hypertension who had transthoracic echocardiography performed on two occasions, with a median of 5 years between echocardiograms, were included in this sub-study (n = 570). Multivariable linear regression analysis was performed to investigate the association between risk factors and changes in LV mass, LAV, GLS and E/e’. ß-values were calculated per 1 SD change for all variables. Results Mean age was 74±3 years, and 55% were men. Mean body mass index (BMI) was 27.8±4.3 kg/m2, 26% had diabetes, 58% used statins, 12% had a history of ischemic heart disease, and 4% had heart failure. The median use of antihypertensive drugs was 2 (IQR: 1,2), mean systolic blood pressure was 148.6±18.2 mmHg. During a median follow-up of 5 years, the mean increase in LV mass was 6.5±38.3g. Male sex (ß 0.24, p < 0.001) and increasing BMI (ß 0.29, p <0.001) were significantly associated with an accelerated increase in LV mass (Fig. 1). The mean increase in LAV was 14.6±15.7ml. Diabetes (ß -0.16, p = 0.006) and high sensitivity C-reactive protein (hsCRP) (ß 0.14, p = 0.007) were significantly associated with changes in LAV (Fig. 2). The absolute decline in mean GLS was 0.27%. Increasing age (ß -0.09, p = 0.027), heart failure (ß -0.10, p = 0.020), ischemic heart disease (ß -0.16, p < 0.001), hsCRP (ß -0.12, p = 0.003) and s-creatinine (ß -0.09, p = 0.033) were all significantly associated with an accelerated decline in GLS (Fig. 1). E/e’ declined with an average 0.96±2.89. Increasing age (ß 0.12, p = 0.001), female sex (ß 0.09, p = 0.049), and increasing systolic blood pressure (ß 0.13, p = 0.004) were associated with an increase in E/e’ (Fig. 2). Conclusion Male sex and increasing BMI were independently associated with an accelerated increase in LV mass. Diabetes was independently associated with LAV decline, while hsCRP was significantly associated with increasing LAV. Increasing age, heart failure, ischemic heart disease, hsCRP, and s-creatinine were independently associated with an accelerated decline in GLS. Increasing age, systolic blood pressure and female sex were independently associated with increasing E/e’.