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

Abstract

Background Hypertrophic cardiomyopathy (HCM) and hypertension coexist fairly frequently in clinical practice. However, the evidence about the impact of hypertension on the prognosis of HCM is limited. The present study aims to investigate the impact of hypertension on the prognosis of HCM patients. Methods A total of 468 HCM patients were enrolled, and patients were divided into hypertension group (31.8%) and non-hypertension group (68.2%). The primary study endpoint was HCM-related death, consisting of heart failure (HF)-related death, stroke-related death and sudden cardiac death (SCD). Associations between hypertension and HCM-related death were analyzed by Cox regression models with the use of propensity score matching (PSM) as primary analysis. Results There were 55 HCM-related death during a median follow-up time of 4.6 years, and the mortality rate was 2.53 per 100 person years. Kaplan-Meier analysis based on the crude cohort or PSM cohort revealed no significant difference regarding the HCM-related death between the two groups. In the crude cohort, both univariable and multivariable Cox regression analysis indicated that hypertension was not significantly associated with HCM-related death with hazard ratios (HR) at 0.74 (95% CI [0.40–1.36], p value: 0.329) and 0.77 (95% CI [0.35–1.71], p value: 0.521), respectively. Similarly, no strong evidence for an association was observed between hypertension and HCM-related death in the PSM cohort with unadjusted HR at 0.90 (95% CI [0.34–2.41]; p value: 0.838) and adjusted HR at 0.77 (95% CI [0.35–1.71]; p value: 0.521), respectively. Other propensity score methods, including overlap weighting and inverse probability treatment weighting demonstrated similar results. Sensitivity analysis also indicated that the concomitant hypertension did not significantly increase the risk of HF-related death, stroke-related death or SCD in HCM patients. Conclusion HCM-related death did not significantly differ between hypertension and non-hypertension groups, suggesting a negative impact of hypertension on the clinical prognosis of HCM patients.

Clinical course of adults with co-occurring hypertrophic cardiomyopathy and hypertension: A scoping review

“…The articles comprise cohorts from Asia (China, Korea), Europe (Spain, United Kingdom, and the European Society of Cardiology Cardiomyopathy and Myocarditis Registry), and the United States. All were observational, 3 prospective [ [25] , [26] , [27] ], and 8 retrospective [ 8 , 10 , 18 , 20 , [28] , [29] , [30] , [31] ]. One study specifically recruited related individuals from a pool of families with HCM, including carriers of HCM-related variants within the MYBPC3 and MYH7 genes [ 25 ], whereas other recruited unrelated individuals, or did not specify whether participants were related.…”

“…One study focused on adults with apical HCM [ 28 ]; 2 focused on adults with obstructive HCM only [ 27 , 29 ], and the rest included adults with varied subtypes of HCM. Six studies defined hypertension and used Joint National Congress 7 (JNC7) criteria, systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or taking anti-hypertensive medication [ 10 , 20 , 22 , 31 , 34 , 35 ]. Article details are presented in Table 1 .…”

“…Follow-up varied across studies, from 3.5 to 10.9 years [ 20 , 25 , 30 ]. Lou et al (2020) examined cardiovascular-related death among those with HCM and hypertension compared to those with HCM alone and did not identify significant differences, 3 (38 %) compared to 5 (71 %), p > 0.05 [ 28 ], whereas Moon et al (2011) found that among adults with apical HCM and adverse cardiovascular events ( N = 110), defined as unplanned hospitalization due to heart failure, stroke, or cardiovascular mortality, hypertension was more prevalent than in adults with apical HCM and no adverse cardiovascular events ( N = 344), 76 (69 %) compared to 156 (46 %), p = 0.0001 [ 26 ].…”

“…Recent advances in the treatment of obstructive HCM have not shown differences between those with and without hypertension, though the science is still evolving [ 17 ]. Management of co-occurring HCM and hypertension is underexplored, constraining clinical decision-making and potentially limiting optimization of outcomes [ [18] , [19] , [20] ].…”

Clinical course and outcomes in adults with co-occurring hypertrophic cardiomyopathy and hypertension: a scoping review protocol

“…While first-line and second-line antihypertensive medications are not contraindicated in adults with non-obstructive HCM, confirming that patients are indeed not obstructed is important, as latent obstruction is sometimes challenging to diagnose and requires a thorough work-up, including provocative non-invasive and invasive manoeuvres, like echocardiographic imaging after eating, or after amyl nitrite administration 16 17. Data on the disease course, treatment and clinical outcomes in patients with both hypertension and HCM is limited, a knowledge gap that constrains clinical decision making and limits optimisation of outcomes 18–20…”