LEFT VENTRICULAR MASS AND DIASTOLIC FUNCTION ARE SIMILAR IN PATIENTS WITH CONTROLLED RESISTANT AND CONTROLLED NON-RESISTANT HYPERTENSION

Abstract

Objective: Patients with resistant hypertension (RHTN) have a higher prevalence of diastolic dysfunction, left ventricular hypertrophy (LVH) and increased of risk of cardiovascular complications compared to patients with more easily controlled hypertension (i.e. controlled non-RHTN)), which is blood pressure (BP) controlled with <=3 antihypertensive medications. RHTN includes patients whose BP is uncontrolled with >=3 medications or controlled with >=4 medications, so called controlled RHTN. The purpose of this study was to determine whether patients with controlled RHTN have higher left ventricular mass index (LVMI) or higher prevalence of LVH or diastolic dysfunction compared to patients with controlled non-RHTN.Design and method: Patients referred to the Hypertension Clinic with controlled RHTN or controlled non-RHTN were enrolled after having 3 consecutive clinic visits with controlled BP (<135/85mmHg). 24-hour ambulatory blood pressure monitoring (ABPM) was done in all subjects to assess out-of-office BP control. Patients with elevated out-of-office BP (>=135/85) were excluded from the analysis. All included subjects underwent cardiac MRIs for measurement of cardiac dimensions and assessment of diastolic function. Diastolic function was assessed by peak filling rate and time needed for recovery of 80% of stroke volume. Results: There was no statistical difference in gender, race, smoking status, or dyslipidemia between the two groups. The prevalence of type 2 diabetes was higher in controlled RHTN patients. There was no difference in mean LVMI between the patients with controlled RHTN versus controlled non-RHTN (55.9 g/m2 vs 52.9 g/m2, respectively, p = 0.325). Likewise, the prevalence of LVH and diastolic dysfunction, as determined by cardiac MRI, was not significantly different between the two groups. Conclusions: In patients with controlled RHTN, there was no difference in mean LVMI values and similar rates of LVH and diastolic dysfunction when compared to patients with controlled non-RHTN. If confirmed in a prospective assessment, the current findings suggest that controlling BP in patients with RHTN reduces LVM and improves diastolic function to levels comparable to those of hypertensive patients who are not resistant to treatment.