Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension

Jeung Ki Yoo, Yoshiyuki Okada, Stuart A. Best, Rosemary S. Parker, Michinari Hieda, Benjamin D Levine, Qi Fu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood. Methods: Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry. Results: Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m2), but it was lower in the normotensive group (41.7 ± 0.9 g/m2; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyn∗s/cm5), whereas controlled HTN group (1925 ± 527 dyn∗s/cm5) was not different to either groups. Conclusion: Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.

Original languageEnglish (US)
Pages (from-to)554-562
Number of pages9
JournalMenopause
Volume25
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Ventricular Remodeling
Hypertension
Vascular Stiffness
Blood Pressure
Analysis of Variance
Pulse Wave Analysis
Mortality
Body Surface Area
Manometry
Vascular Resistance
Antihypertensive Agents
Blood Vessels
Longitudinal Studies
Magnetic Resonance Imaging
Pharmaceutical Preparations

Keywords

  • Arterial load
  • Controlled hypertension
  • Older women
  • Uncontrolled hypertension
  • Ventricular hypertrophy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension. / Yoo, Jeung Ki; Okada, Yoshiyuki; Best, Stuart A.; Parker, Rosemary S.; Hieda, Michinari; Levine, Benjamin D; Fu, Qi.

In: Menopause, Vol. 25, No. 5, 01.05.2018, p. 554-562.

Research output: Contribution to journalArticle

Yoo, Jeung Ki ; Okada, Yoshiyuki ; Best, Stuart A. ; Parker, Rosemary S. ; Hieda, Michinari ; Levine, Benjamin D ; Fu, Qi. / Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension. In: Menopause. 2018 ; Vol. 25, No. 5. pp. 554-562.
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AU - Hieda, Michinari

AU - Levine, Benjamin D

AU - Fu, Qi

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AB - Objective: The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women, and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood. Methods: Nineteen women with uncontrolled hypertension on drug treatment (70 ± 2 [SE] years, ambulatory awake blood pressure; 152 ± 2/84 ± 2 mm Hg), 19 with controlled hypertension (68 ± 1 years, 128 ± 2/71 ± 2 mm Hg), and 31 healthy normotensive women (68 ± 1 years, 127 ± 1/73 ± 1 mm Hg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in before cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac magnetic resonance imaging. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry. Results: Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs controlled: 50.0 ± 1.7 vs 51.8 ± 2.3 g/m2), but it was lower in the normotensive group (41.7 ± 0.9 g/m2; one-way analysis of variance [ANOVA] P = 0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5 ± 0.6 vs 11.1 ± 0.5 m/s) and lower in the normotensive group (9.1 ± 0.3 m/s; 1-way ANOVA P = 0.0001). Total peripheral resistance was greater in uncontrolled hypertension (HTN) compared with normotensive group (2051 ± 323 vs 1719 ± 380 dyn∗s/cm5), whereas controlled HTN group (1925 ± 527 dyn∗s/cm5) was not different to either groups. Conclusion: Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared with normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.

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KW - Ventricular hypertrophy

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