TY - JOUR
T1 - Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension
AU - Yoo, Jeung Ki
AU - Okada, Yoshiyuki
AU - Best, Stuart A.
AU - Parker, Rosemary S.
AU - Hieda, Michinari
AU - Levine, Benjamin D
AU - Fu, Qi
N1 - Funding Information:
Received August 14, 2017; revised and accepted November 7, 2017. From the 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX; and 2The University of Texas Southwestern Medical Center, Dallas, TX. Funding/support: Supported by NIH R01 HL091078 grant. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Qi Fu, MD, PhD, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231-8205. E-mail: FuQi@texashealth.org
Publisher Copyright:
© 2017 by The North American Menopause Society.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective: The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood. Methods: Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry. Results: Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m 2 ), but it was lower in the normotensive group (41.7 ± 0.9 g/m 2 ; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyn∗s/cm 5 ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm 5 ) was not different to either groups. Conclusion: Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.
AB - Objective: The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood. Methods: Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry. Results: Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m 2 ), but it was lower in the normotensive group (41.7 ± 0.9 g/m 2 ; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyn∗s/cm 5 ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm 5 ) was not different to either groups. Conclusion: Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.
KW - Arterial load
KW - Controlled hypertension
KW - Older women
KW - Uncontrolled hypertension
KW - Ventricular hypertrophy
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U2 - 10.1097/GME.0000000000001046
DO - 10.1097/GME.0000000000001046
M3 - Article
C2 - 29257033
AN - SCOPUS:85045424338
SN - 1072-3714
VL - 25
SP - 554
EP - 562
JO - Menopause
JF - Menopause
IS - 5
ER -