Retrospective analysis of clinical phenotype and prognosis of hypertrophic cardiomyopathy complicated with hypertension

Abstract

We here studied the clinical features, cardiac structure, and functional changes and prognosis of hypertrophic cardiomyopathy (HCM) patients with hypertension (HTN). A total of 90 HCM patients with HTN and 172 patients without HTN were divided into a hypertensive group and non-hypertensive group. the clinical characteristics, cardiac structure and function, and prognosis of the two groups were compared. our study found that HcM patients with Htn had fewer syncope events in their medical histories (8% vs. 22%, P < 0.01) and sudden deaths in the family (3% vs. 10%, P < 0.05). The prevalence of apical hypertrophy (18% vs. 7%, P < 0.01) and midventricular obstruction (26% vs. 15%, P < 0.05) was higher in the Htn group. Besides, simple HcM patients had more pathogenic gene mutations, while those with HTN were more likely to have mutations of uncertain clinical significance (64% vs. 24%, P < 0.05). Evaluation of 5-year survival rate showed a trend for a worse prognosis in HCM patients with HTN, but the results were not statistically insignificant (P = 0.065). In conclusion, we found that the clinical phenotypes of HCM patients with HTN differed from those of patients with HCM alone, suggesting that Htn may play a pathogenic role in the pathogenesis of hypertensive hypertrophic cardiomyopathy patients.

The impact of hypertension on the prognosis of patients with hypertrophic cardiomyopathy: a single-center retrospective study

“…Consistent with previous studies ( Luo et al, 2020 ; Deng et al, 2019 ; Aslam et al, 2010 ), the clinical features of HCM patients with hypertension in the present study were characterized by older age, higher application of other antihypertensive drugs except β blockers, such as renin-angiotensin system inhibitors (RASIs), dihydropyridine calcium channel antagonists (DHP-CCBs) and hydrochlorothiazide. Vasodilators were the most effective and tolerable drugs for blood pressure control but could exacerbate LVOTO.…”

“…Vasodilators were the most effective and tolerable drugs for blood pressure control but could exacerbate LVOTO. Historical studies indicated that the presence of LVOTO did not differ between HCM patients with hypertension or those without hypertension ( Luo et al, 2020 ; Aslam et al, 2010 ). While the prevalence of LVOTO was much higher in the hypertension group of our study.…”

“…On the other hand, the management of hypertension relies on antihypertensive drugs, some of which except beta-blockers may be contraindicated in HCM patients, especially in patients with obstructive HCM ( Ommen et al, 2020 ). Previous studies have demonstrated that concomitant hypertension could affect cardiac structure in HCM patients, while the clinical outcomes, such as 5-year survival rate or cardiac death did not significantly differ between HCM patients with or without hypertension ( Luo et al, 2020 ; Deng et al, 2019 ; Aslam et al, 2010 ). However, those studies had relatively small population, and mainly focused on all-cause mortality or cardiac mortality.…”

Cardiomyopathies in China: A 2018–2019 state‐of‐the‐art review

“…Furthermore, comorbidity influencing hemodynamics should be considered in outcome prediction. 66 , 67 , 68 , 69 , 70 …”

“…Procollagen type I carboxy‐terminal propeptide and matrix metalloproteinase‐2 levels in both plasma and myocardial tissues were consistent, reflecting myocardial fibrosis. Furthermore, comorbidity influencing hemodynamics should be considered in outcome prediction 66–70 …”