DILATED CARDIOMYOPATHY WITH HYPERTENSION: PREVALENCE AND RESPONSE TO HIGH‐DOSE β₁‐ADRENOCEPTOR ANTAGONIST THERAPY

Abstract

1. The aim of the present study was to investigate the prevalence of hypertension in patients with dilated cardiomyopathy (DCM) and to determine the tolerance and efficacy of a high dose of the β1-adrenoceptor antagonist metoprolol in the long-term treatment of DCM patients. 2. The prevalence of hypertension in DCM patients (n = 362) and age-matched controls (n = 401) was evaluated and compared. To investigate the effects of metoprolol, DCM patients were divided into hypertensive (DCM-H) or normotensive (DCM-N) subgroups. Metoprolol was administered at a starting dosage of 6.25 mg/day and increased gradually to 250 mg/day or the maximum tolerable dose. Blood pressure (BP), heart rate (HR), left ventricular (LV) end-diastolic dimension (LVEDD), left atrial end-diastolic dimension (LAEDD), LV ejection fraction (LVEF), LV posterior wall thickness (LVPWT) and ventricular septal thickness (VST) were determined at baseline and 6 and 12 months after metoprolol treatment. 3. The prevalence of hypertension was significantly higher in DCM patients than in age-matched controls (32.8 vs 20.1%, respectively; P < 0.01). Resting HR and a family history of hypertension were highest in the DCM-H group. There were no significant differences in age, gender and occupation between the DCM-H, DCM-N and age-matched control groups. 4. The tolerable dose for metoprolol was significantly higher in the DCM-H group than the DCM-N group (189.6 ± 14.8 vs 133.9 ± 12.0 mg/day, respectively; P < 0.05). Metoprolol significantly reduced BP and HR in the DCM-H group and improved LVEDD, LAEDD and LVEF in all DCM patients, with a greater effect seen in the DCM-H group. 5. In conclusion, DCM patients have a higher prevalence of hypertension than the general population. Patients in the DCM-H subgroup were characterized by a higher resting HR and a family history of hypertension and were more tolerant of and more responsive to metoprolol treatment. These data suggest that this subgroup of DCM patients could have higher sympathetic nerve activity and is suitable for treatment with a higher dose of metoprolol.

The Impact of Hypertension on Left Ventricular Function and Remodeling in Non‐Ischemic Dilated Cardiomyopathy Patients: A 3.0 T MRI Study

“…Hypertension is a growing health issue that leads to many cardiovascular complications, and the prevalence of hypertension is higher in patients with NIDCM than in the general population. 11 Previous studies have shown that hypertension alone can lead to myocardial dysfunction, myocardial fibrosis, and LV remodeling. 24,25 However, little is known about the impact of hypertension on LV strain and remodeling in patients with NIDCM.…”

“…10 A previous study indicated that the prevalence of hypertension is higher in patients with NIDCM than in age-matched controls. 11 It has been reported that hypertension is an important risk factor for adverse outcomes in patients with NIDCM, and NIDCM patients comorbid with hypertension have been shown to have a higher risk of sustained ventricular arrhythmias. 12 Thus, considering the poor prognosis among NIDCM patients with hypertension, it would be important to determine the effects of hypertension on LV alterations in NIDCM patients.…”

A Mitochondrial DNA A8701G Mutation Associated with Maternally Inherited Hypertension and Dilated Cardiomyopathy in a Chinese Pedigree of a Consanguineous Marriage

“…Clinical trials have shown that hypertension is one of the potential risk factors for DCM. [ 1 2 ] Considering the central role of mitochondria in the production of energy and reactive oxygen species (ROS), mutations in mitochondrial DNA (mtDNA) are believed to affect the pathogenesis of hypertension. [ 3 ] Evidence supports the notion that somatic mtDNA damage is a good predictor of hypertension.…”

The Association of Dilated Cardiomyopathy with Essential Hypertension

“…Bagger et al during 2 year observation had found out only 2 cases of DCMP accompanied by EH per 41 cases of morphologically proved DCMP. But Zheng X. et al, 2009 at his paper demonstrated that the prevalence of arterial hypertension among DCMP patients is higher than in the same group without hypertension. Our data suggested that combination of DCMP and EH is very rare.…”