Effect of long-term antihypertensive therapy on myocardial strain: a meta-analysis

Abstract

Evidence on the impact of blood pressure (BP)lowering drugs on left ventricular (LV) mechanics in hypertension is still limited. We performed a meta-analysis of speckle-tracking echocardiographic studies in order to provide a new piece of information on this topic. Methods:The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to 31 October 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular hypertrophy', 'systemic hypertension', 'BP lowering drugs,' 'antihypertensive therapy'.Results: A total of 1140 hypertensive patients (mean age 55.4 years, 50% men, follow-up 6-36 months) were included in eight studies. Pretreatment and posttreatment pooled SBP/DBPs were 148.4 AE 3.5/88.7 AE 2 vs. 127.4 AE 1.9/77.8 AE 0.9 mmHg. Corresponding values for ejection fraction (EF), LV mass (LVM) index, and global longitudinal strain (GLS) were 64 AE 2.3 vs. 65.9 AE 1.7% (SMD: 0.14 AE 0.03, CI 0.08-0.20, P ¼ 0.001); 108.4 AE 11.2 vs. 100.2 AE 11.0 g/m 2 (SMD: À0.27 AE 0.10, CI À0.46 to À0.08, P < 0.01); À17.7 AE 0.6 vs. À19.6 AE 0.4%, (SMD 0.26 AE 0.03, CI 0.20-0.32, P < 0.0001), respectively. A meta-regression analysis showed a significant relation between GLS improvement and the extent of reduction of LVMI (P ¼ 0.0003), but not of SBP (P ¼ 0.27). Conclusion:Our meta-analysis suggests that antihypertensive treatment has a clear beneficial effect on LV mechanisms, and the improvement in GLS is mainly related to the reduction in LVMI rather than SBP.

Effects of intensive blood‐pressure treatment on myocardial work in elderly hypertensive patients: A subcenter study of the STEP randomized controlled trial

“…However, we found both groups with stable SBP control decreased GLS from phase 1 to 2 without significant difference between treatment effects. Meanwhile, no association was found between SBP reduction and GLS improvement in the above study 22 . This equivocal result could be explained by cardiac interstitial fibrosis, which develops in HHD and is associated with reduced GLS 23 .…”

“…A meta‐analysis research included 1140 hypertensive patients (mean age 55.4 years, 50% men, follow‐up 6–36 months) containing 8 studies demonstrated that antihypertensive treatment was associated with the improvement in GLS 22 . However, we found both groups with stable SBP control decreased GLS from phase 1 to 2 without significant difference between treatment effects.…”

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

“…123,124 : GLS has shown to be able to unmask systolic dysfunction undetected by conventional LVEF, 125 also in specific settings as masked hypertension 126 and non-dippig pattern 127 ; furthermore, antihypertensive treatment has shown a clear beneficial effect on LV mechanisms, leading to improvements in GLS. 128 Sarcomeric and non-sarcomeric HCMs are typically characterized by heterogeneous echocardiographic patterns of LVH, often with a normal or supernormal EF. 129 However, all components of strain are reduced in these patients.…”

Predictors of Impaired Left Ventricular Global Longitudinal Strain in Patients with Essential Hypertension and Preserved Ejection Fraction

“…Patients with HT and asymptomatic SLVSD derive the greatest benefit from appropriate pharmacotherapy [42]. Generally, the improvement in GLS is largely related to the reduction in LVMI rather than mere BP lowering [43].…”