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

Feng, Xiaoxuan1; Yan, Mengqi1; Tang, Linghui2; Zhou, Dan3; Wu, Shiping1; Cai, Jun4; Feng, Yingqing1,5

2023-10-01

10.1002/clc.24172

CLINICAL CARDIOLOGY   Impact Factor & Quartile

0160-9289

1932-8737

Background: The benefits and safety of intensive blood pressure treatment in elderly hypertensive patients have been proved in the STEP trial. However, relevant mechanisms for intensive treatment are lacking.Hypothesis: We aimed to explore whether intensive blood pressure treatment is associated with left ventricular systolic function changes as evaluated by myocardial work (MW) parameters in elderly hypertensive patients compared to the standard.Methods: Patients were randomized to the intensive group (n = 66, median age 66 years, 42.4% male) with a systolic blood pressure (SBP) goal of 110 to <130 mmHg or the standard treatment group (n = 50, median age 63.5 years, 30% male) with an SBP goal of 130-<150 mmHg in this subcenter study of the STEP trial. There was no pre-randomization echocardiographic collected. Echocardiographic exam was produced at 1-year (phase 1) and 3-year (phase 2) post-randomization.Results: In phase 1, SBP was already significantly lower in the intensive treatment group than in the standard treatment group (126.5 vs. 132.1 mmHg, p < .05). During a median follow-up of 40 months, in phase 2, the intensive group still had a lower SBP than the standard treatment group (125.0 vs. 135.3 mmHg, p < .05). Both global work index (GWI) and global constructive work (GCW) decreased significantly in phase in the intensive treatment group but not in the standard group (p < .05). Global wasted work (GWW) increased and global work efficiency (GWE) declined in both groups from phase 1 to phase 2 while no significant difference between the treatment effects. Similarly, left ventricular ejection function (LVEF) and global longitudinal strain (GLS) decreased in the two groups. The multivariate linear regression analysis showed the intensive treatment appeared to be an independent predictor of the Delta GWI (beta = -110.92; 95% CI, -197.78 to -30.07, p = .008) and Delta GCW (beta = -135.11; 95% CI, -220.33 to -49.88, p = .002).Conclusions: In elderly hypertensive patients, lower SBP was associated with decreased GWI and GCW and intensive BP treatment did not improve global MW efficiency.

elderly hypertension intensive blood pressure treatment left ventricular myocardial work

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We are grateful for the contributions made by each and every one of the people who work on the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. We also appreciate the time and effort contributed by all participants[2019B020227005] ; Key Ramp;D Program of Guangdong Province[2017B030314041] ; Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention[DFJH2020022] ; Climbing Plan of Guangdong Provincial Peopleapos;s Hospital[2020B1111170011]

Cardiovascular System & Cardiology

Cardiac & Cardiovascular Systems

WOS:001082898500001

WILEY

CLINICAL MEDICINE

Web of Science

1.Southern Med Univ, Guangdong Prov Peoples Hosp, Guangdong Acad Med Sci, lnstitute Hypertens, Guangzhou, Peoples R China
2.Second Peoples Hosp Nanhai Dist Foshan City, Guangdong Prov Peoples Hosp, Nanhai Hosp, Dept Cardiol, Foshan, Peoples R China
3.Southern Univ Sci & Technol, Jinan Univ, Shenzhen Peoples Hosp, Affiliated Hosp 1,Clin Med Coll 2,Dept Internal Me, Shenzhen, Peoples R China
4.Chinese Acad Med Sci & Peking Union Med Coll, Fuwai Hosp, Natl Ctr Cardiovasc Dis China, State Key Lab Cardiovasc Dis China,Hypertens Ctr, Beijing, Peoples R China
5.Southern Med Univ, Guangdong Prov Peoples Hosp, Guangdong Cardiovasc Inst, Guangdong Acad Med Sci,Guangdong Prov Key Lab Coro, 106 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, Peoples R China

Feng, Xiaoxuan,Yan, Mengqi,Tang, Linghui,et al. Effects of intensive blood-pressure treatment on myocardial work in elderly hypertensive patients: A subcenter study of the STEP randomized controlled trial[J]. CLINICAL CARDIOLOGY,2023.

Feng, Xiaoxuan.,Yan, Mengqi.,Tang, Linghui.,Zhou, Dan.,Wu, Shiping.,...&Feng, Yingqing.(2023).Effects of intensive blood-pressure treatment on myocardial work in elderly hypertensive patients: A subcenter study of the STEP randomized controlled trial.CLINICAL CARDIOLOGY.

Feng, Xiaoxuan,et al."Effects of intensive blood-pressure treatment on myocardial work in elderly hypertensive patients: A subcenter study of the STEP randomized controlled trial".CLINICAL CARDIOLOGY (2023).