Abstract P121: Medical Treatment And Outcomes In Adults With Co-occurring Hypertrophic Cardiomyopathy And Hypertension: A Scoping Review

Abstract

Background: Over 50% of adults with hypertrophic cardiomyopathy (HCM) have co-occurring hypertension (HTN). Therapeutic management poses a clinical challenge as first and second-line antihypertensive medications (AHM) can worsen obstructive HCM (OHCM), which comprises ~70% of all HCM. Treatment and clinical course in adults with HCM+HTN are underexplored. With this scoping review, we sought to 1) characterize the literature on the management and outcomes of HCM+HTN, and 2) identify knowledge gaps to inform future research directions. Methods: We searched 5 databases (PubMed, CINAHL, Scopus, Embase, Web of Science) to identify and review eligible articles: 1) peer-reviewed; 2) English-language; 3) cohorts with an established HCM diagnosis; 4) data on management, and/or outcomes related to co-occurring HTN; 5) published 2011 - 2023. We reviewed reference lists of eligible articles to find other relevant studies. The review was conducted according to PRISMA ScR guidelines, with 2 independent reviewers at each stage of review. Results: We extracted data from 12 articles (of 966 results); all were retrospective observational. Five defined HTN (JNC7 criteria and/or AHM). One study examined HTN in adults with apical HCM, 2 in adults with OHCM, and 9 did not differentiate HCM phenotype. Only 1 study described a medication strategy for treating HCM+HTN, showing that prioritizing β1 selective blockers and verapamil over direct vasodilators led to improvement in functional (NYHA) class and lower blood pressure. There was notable heterogeneity in definitions and analytic methods related to outcomes. Four studies showed worse renal function in those with HCM+HTN versus HCM alone, but results were equivocal in other outcomes, including stroke, cardiovascular disease, atrial fibrillation, surgical interventions for HCM, and sudden death. All-cause mortality was similar between those with HCM+HTN and HCM alone. Conclusions: To our knowledge, this is the first scoping review to examine the literature on the clinical course and outcomes of patients with HCM+HTN. Our results highlight the critical need for further research to improve understanding of co-occurring HCM and HTN, with particular focus on medical management to optimize clinical course and outcomes.