Rapid treatment of moderate to severe hypertension using a novel protocol in a single-centre, before and after interventional study

Journal of Cardiovascular Magnetic Resonance

Fulford

Gooding

et al. 2021

Self Cite

Background Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis. Methods We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment. Results We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (− 20.8 ± 4.9 to − 19.1 ± 3.7, p = 0.02), apical circumferential strain (− 26.0 ± 5.3 to − 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003). Conclusions LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes. Trial registration: ISRCTN registry number: 57475376 (assigned 25/06/2015).

Section: Methodsmentioning

confidence: 99%

“…We planned to enroll 50 participants into a clinical study of the feasibility and safety of rapid treatment of grade II/III hypertension [ 20 ]. Of these, 75% recruitment to paired CMR studies was anticipated.…”

Section: Methodsmentioning

confidence: 99%

Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study

Journal of Cardiovascular Magnetic Resonance

Fulford

Gooding

et al. 2021

Self Cite

“…Responsiveness was tested through administration of the instrument before and after 18 weeks' intensive treatment of hypertension, using medications and medication combinations recommended in current international guidelines, though over an accelerated timeframe (27), an intervention that seemed to have a measurable signi cant impact on genetic quality of life as measured through the visual analogue scale of the EQ-5D-5L (large effect size), but not on the EQ-5D-5L index (small effect size). The effect size for the StM scale was larger than for the EQ-5D-5L index, but not statistically signi cant due to a high dispersion of scores, and was negligible for the SM scale.…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this study was therefore to translate, adapt and evaluate the psychometric performance of the existing MINICHAL for its use in the United Kingdom. Within this, we aimed to test responsiveness to change of the instrument through administration before and after an 18-week intensive treatment programme for subjects with newly diagnosed grade II-III hypertension (27). The MINICHAL instrument was obtained from its original publication in Spanish(16) (Fig.…”

Section: Introductionmentioning

confidence: 99%

Cross-Cultural Adaptation of The Spanish MINICHAL Instrument Into English For Use In The United Kingdom

Anning

Wilkes

et al. 2021

Preprint

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Background: Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process, using a cohort of patients enrolled in an 18-week programme for the treatment of grade II-III hypertension. Methods: The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population. Results: The final version of the instrument was administered to 30 individuals with grade II/III hypertension before and after 18 weeks’ intensive treatment. Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach’s alpha = 0.81 and 0.75), as was test-retest reliability (ICC=0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ5d5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ5D5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d=0.32 and 0.02 respectively). Conclusions: The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II/III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration: ISRCTN registry number: 57475376 (assigned 25/06/2015).

Section: Introductionmentioning

confidence: 99%

Cross-cultural adaptation of the Spanish MINICHAL instrument into English for use in the United Kingdom

Health Qual Life Outcomes

Anning

Wilkes

et al. 2022

Self Cite

Background Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process. Methods The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population of patients living in the Exeter area (Southwest UK) aged 18–80 years with treatment-naïve grade II-III hypertension, before, during and after 18 weeks’ intensive treatment. Results The English-language instrument was administered to 30 individuals (median age: 58.5 years, 53% male). Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach’s alpha = 0.81 and 0.75), as was test–retest reliability (ICC = 0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ-5D-5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ-5D-5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d = 0.32 and 0.02 respectively). Conclusions The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II-III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration ISRCTN registry number: 57475376 (assigned 25/06/2015).