JCMR 2021; 23.122. Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study-Article

Article

Pdf Summary

This cohort study examined whether rapid, guideline-based treatment of newly diagnosed grade II/III hypertension improves heart structure and function within 18 weeks. Forty-one treatment-naïve adults completed paired cardiovascular magnetic resonance (CMR) scans before and after intensive antihypertensive therapy.<br /><br />After 18 weeks, blood pressure fell substantially and left ventricular hypertrophy regressed. Left ventricular mass index decreased from 43.5 to 37.6 g/m², and absolute left ventricular mass and wall thickness also fell. These structural improvements were associated with changes in cardiac mechanics. Left ventricular ejection fraction, stroke volume, and left ventricular end-diastolic volume all declined slightly. Feature-tracking CMR showed reduced radial strain, lower mid- and apical circumferential strain, and reduced apical rotation; longitudinal strain tended to improve but was not statistically significant. Left atrial volume and sphericity index did not change significantly.<br /><br />The study also identified late gadolinium enhancement in 23% of participants who underwent contrast imaging, suggesting focal non-ischemic myocardial fibrosis in some patients with treatment-naïve hypertension. No change in enhancement pattern was seen after treatment.<br /><br />Overall, the findings show that left ventricular hypertrophy can regress rapidly—within just 18 weeks—when hypertension is treated aggressively. The accompanying myocardial functional changes may reflect early beneficial remodeling and support current European guideline recommendations to bring grade II/III hypertension under control within about 3 months. The authors note that a randomized trial would be needed to confirm whether these imaging changes translate into better long-term clinical outcomes.

Keywords

hypertension

left ventricular hypertrophy

cardiovascular magnetic resonance

antihypertensive therapy

myocardial remodeling

left ventricular mass index

feature-tracking CMR

ejection fraction

late gadolinium enhancement

guideline-based treatment