Impact of antihypertensive treatment on myocardial mechanics in elderly hypertensive patients with different left ventricular geometry patterns: a two-dimensional speckle-tracking echocardiography study.

Abstract

Background: Hypertension can cause left ventricular remodeling, and the degree of myocardial mechanical damage is different in patients with different geometries. Antihypertensive treatment can improve myocardial mechanics, but the improvement in myocardial mechanics in hypertensive patients with different geometries is not clear. This study aimed to assess the impact of antihypertensive therapy on myocardial mechanics in elderly patients diagnosed with primary hypertension, considering diverse left ventricular geometry patterns.

Methods: This study conducted a retrospective cohort analysis by randomly selecting 221 elderly patients diagnosed with primary hypertension from the outpatient department of Bethune Hospital in Shanxi Province, between January and June 2017. In this study, we included 191 elderly hypertensive patients (mean age 67.71±3.26 years, 98 women) who had successfully attained the target blood pressure levels through the administration of antihypertensive medications. The participants were stratified into distinct left ventricular geometry categories, namely normal geometry (NG; 54 cases), concentric remodeling (CR; 42 cases), eccentric hypertrophy (EH; 41 cases), and concentric hypertrophy (CH; 54 cases). The four groups were compared in terms of the global longitudinal strain (GLS) and its changes at baseline and 12 and 24 months after antihypertensive therapy.

Results: The baseline GLS exhibited a gradual decrease in the following sequence: NG, CR, EH, and CH groups (all P<0.05). GLS demonstrated improvement in the CR, EH, and CH groups after 12 and 24 months of treatment; the GLS of CR group changed from -19.65%±1.27% to -20.72%±2.06%, then to -21.25%±1.99%; EH group changed from -18.76%±1.39% to -20.57%±1.75%, then to -21.37%±1.88%; CH group increased from -17.51%±1.42% to -20.04%±2.17%, then to -20.81%±2.51% (all P<0.05). After 24 months of treatment, GLS in the NG group improved from -20.84%±1.36% at baseline to -21.90%±1.99% (P<0.05). Within the CR, EH, and CH groups, the improvement in GLS (∆GLS) following 12 months of treatment exceeded ∆GLS between 12 months and 24 months of treatment (all P<0.05). ∆GLS after 12 months of treatment progressively increased in the order of NG, CR, EH, and CH groups (all P<0.05), while ∆GLS between 12 and 24 months of treatment exhibited similarity across the four groups (P>0.05).

Conclusions: The degree of myocardial mechanical damage is different in elderly primary hypertensive patients with different left ventricular geometries. After antihypertensive treatment, the myocardial mechanical damage continues to improve in all groups, and the concentric hypertrophy group had the most significant improvement.