Impact of blood pressure management on cardiac mechanics and vascular function in patients with resistant hypertension- a longitudinal study
Authors: Akhmimi A , Sprung V S , Lip G Y H , Oxborough D , Shantsila A 
Published: January 2025

Abstract

Introduction
Resistant hypertension (RH) has been associated with increased arterial stiffness, impaired endothelial function, and abnormalities in cardiac mechanics. However, the impact of intensified blood pressure (BP) management on improving arterial stiffness, endothelial function, and especially left ventricular (LV) and left atrial (LA) mechanics in patients with RH remains unknown.

Purpose
The aim of this study was to examine the effects of intensified BP management on LV and LA mechanics, arterial stiffness, and endothelial function in people living with RH.

Methods
A prospective longitudinal study in which 16 RH patients (mean age 61±12 years; 37.5% females) were followed up for eight weeks after the intensification of antihypertensive treatment was initiated in a specialised hypertension clinic. Participants underwent anthropometric assessment, office and central BP measurements, pulse wave analysis to assess arterial stiffness determined by aortic augmentation index (AIx), brachial artery flow-mediated dilatation (FMD) to assess endothelial function, transthoracic echocardiography, and two-dimensional speckle tracking echocardiography analysis to assess LV and LA mechanics. Paired t-test and Wilcoxon signed-rank test were utilised to compare parametric data and non-parametric data, respectively.

Results
Following 8-weeks of optimising antihypertensive treatment, patients with RH demonstrated a reduction in both office systolic and diastolic BP (change of -16/-12 mmHg, P&lt;0.001) and central systolic and diastolic BP (change of -17/-6 mmHg, P=0.002). RH patients exhibited reduced AIx (Baseline: 24.7% [21.7 – 35.0] vs follow-up: 16.7% [14.0 – 22.5], P&lt;0.001) as well as improved FMD response compared to baseline (Baseline: 3.1±1.7% vs follow-up: 5.1±1.9%, P&lt;0.001). Improvements in LV peak systolic global longitudinal strain (Baseline: -16.6±1.9% vs follow-up: -18.6±2.2%, P&lt;0.001), circumferential strain (Baseline: -18.1±3.7% vs follow-up: -19.8±3.4%, P=0.002), and radial strain (Baseline: 32.3±8.2% vs follow-up: 35.1±7.3%, P&lt;0.001) were also observed. No differences were detected in LV twist (Baseline: 10.6±2.9° vs follow-up: 10.0±2.3°, P=0.24). For the LA longitudinal strain indices, notable enhancements only in the LA reservoir strain (Baseline: 24.5±6.4% vs follow-up: 28.6±6.6%, P&lt;0.001) and conduit strain (Baseline: -12.7±5.2% vs follow-up: -15.3±5.9%, P=0.009) were evident, with no difference in the LA contractile strain, compared to baseline (Baseline: -11.9% [-13.5 – -8.5] vs follow-up: -12.5% [-15.2 – -10.5] P=0.12) (Table 1).

Conclusion
Intensive BP management in patients with RH was effective in improving LV and LA mechanics, arterial stiffness, and endothelial function. These novel data identify important mechanistic effects of intensive BP treatment but also highlight the need for future studies to determine whether their improvements are associated with better clinical outcomes.