Determinants of concentric left ventricular hypertrophy in patients with resistant hypertension: RESIST-POL study

Abstract

Left ventricular hypertrophy, especially concentric hypertrophy, has been shown to be an independent factor of cardiovascular diseases in patients with hypertension. Obstructive sleep apnea (OSA) and/or metabolic syndrome (MS) are common in patients with resistant hypertension (RHTN). The aim of this study was to evaluate factors associated with concentric hypertrophy in patients with RHTN. Data from 155 patients (92M, 63F) was analyzed. All patients underwent a thorough examination including: biochemical evaluations, ambulatory blood pressure monitoring, polysomnography and echocardiography. MS was defined by The Adult Treatment Panel III. Clinically significant OSA was defined as apnea/hypopnea index (AHI)>15 events per hour. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. Four types of LV geometry were distinguished based on the LVMI and RWT. Patients were divided into four groups based on the LV geometric patterns: group 1 (normal geometry) (n=38, 24.4%); group 2 (concentric remodeling) (n=40, 25.8%); group 3 (eccentric hypertrophy) (n=26, 16.8%); and group 4 (concentric hypertrophy) (n=51, 33%). MS was found in 64% and OSA (AHI>15) in 43.2% of patients. Factors independently associated with concentric hypertrophy were: age (OR-1.51; 95% CI-1.00-2.27; P<0.04), OSA>15 events per hour (OR-2.73; 95% CI-1.26-5.93; P=0.01) and nighttime systolic blood pressure (SBP) (OR-1.69; 95% CI-1.32-2.17; P=0.0001). Concentric hypertrophy was the most common type of left ventricular disorder in patients with RHTN. Nighttime SBP and clinically significant OSA were independently associated with concentric hypertrophy in patients with RHTN.

The prevalence and predictors of resistant hypertension in high‐risk overweight and obese patients: A cross‐sectional study based on the 2017 ACC/AHA guidelines

“…On multivariate regression analysis, patients with true RH in the current study were more likely to be black, and to have a higher mean BMI, medical history of DM requiring insulin, HFpEF, and CKD stage 3 or higher (Table ). These findings are consistent with those of prior studies conducted on RH subjects across all ranges of BMI values . DM and insulin resistance are associated with true RH, and this association is further amplified when DM is complicated with microvascular disease .…”

Hypertension and obstructive sleep apnea

“…Furthermore, two cross-sectional studies revealed that there was dose-effect relationship between the severity of OSA and the magnitude of BP increase, as well as the number of anti-hypertensive medicines used to manage hypertension. 39,40 In recent times, a clinical study revealed that clinically significant OSA was independently associated with concentric hypertrophy in patients with resistant hypertension, 41 which suggests that OSA might accelerate the adverse cardiovascular remodeling in subjects with resistant hypertension.…”

Morphometric changes of the left ventricle and characteristics of peripheral hemodynamics in patients with drug resistant hypertension

“…Так, у пациентов с контролируемой АГ чаще формируется концентри-ческое ремоделирование миокарда ЛЖ, в то время как у пациентов с РАГ формируется концентрическая гипертрофия миокарда ЛЖ, несмотря на одинаковый стаж АГ, что, вероятно, связано с более интенсивным процессом развития гипертрофии и фиброза мио-карда ЛЖ [19], присущих для этой группы пациентов. Кроме того, перегрузка ЛЖ давлением, нарушения диастолической функции ЛЖ приводят к перегрузке ЛП и сопровождаются увеличением его размера, который у пациентов с РАГ стремится к предельным значениям, достижение которого увеличивает риск развития фибрилляции предсердий [20].…”