Left Ventricular Remodeling and Arterial Afterload in Older Women with Uncontrolled and Controlled Hypertension

Overview

Journal Menopause

Specialty Gynecology & Obstetrics

Date 2017 Dec 20

PMID 29257033

Citations 2

Authors

Jeung-Ki Yoo

Yoshiyuki Okada

Stuart A Best

Rosemary S Parker

Michinari Hieda

Benjamin D Levine

Qi Fu

Affiliations

Soon will be listed here.

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/m), but it was lower in the normotensive group (41.7 ± 0.9 g/m; 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 dyns/cm), whereas controlled HTN group (1925 ± 527 dyns/cm) 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.

Citing Articles

Greater resting muscle sympathetic nerve activity reduces cold pressor autonomic reactivity in older women, but not older men.

Akins J, Okada Y, Hendrix J, Vongpatanasin W, Fu Q Am J Physiol Regul Integr Comp Physiol. 2023; .

PMID: 36971420 PMC: 10110704. DOI: 10.1152/ajpregu.00231.2022.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China.

Peng H, Sun M, Hu X, Han H, Su J, Peng E PeerJ. 2022; 10:e13365.

PMID: 35535240 PMC: 9078134. DOI: 10.7717/peerj.13365.

References

Berry K, Cameron J, Dart A, Dewar E, Gatzka C, Jennings G . Large-artery stiffness contributes to the greater prevalence of systolic hypertension in elderly women. J Am Geriatr Soc. 2004; 52(3):368-73. DOI: 10.1111/j.1532-5415.2004.52107.x. View

Andersson O, Almgren T, Persson B, Samuelsson O, Hedner T, Wilhelmsen L . Survival in treated hypertension: follow up study after two decades. BMJ. 1998; 317(7152):167-71. PMC: 28606. DOI: 10.1136/bmj.317.7152.167. View

Levy D, Garrison R, Savage D, Kannel W, CASTELLI W . Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990; 322(22):1561-6. DOI: 10.1056/NEJM199005313222203. View

Staessen J, van der Heijden-Spek J, Safar M, Den Hond E, Gasowski J, Fagard R . Menopause and the characteristics of the large arteries in a population study. J Hum Hypertens. 2001; 15(8):511-8. DOI: 10.1038/sj.jhh.1001226. View

Laszlo G . Respiratory measurements of cardiac output: from elegant idea to useful test. J Appl Physiol (1985). 2004; 96(2):428-37. DOI: 10.1152/japplphysiol.01074.2001. View

AlFakih K, Reid S, Hall A, Sivananthan M . The assessment of left ventricular hypertrophy in hypertension. J Hypertens. 2006; 24(7):1223-30. DOI: 10.1097/01.hjh.0000234097.47379.fd. View

Amigoni S, Morelli P, Parazzini F, Chatenoud L . Determinants of elevated blood pressure in women around menopause: results from a cross-sectional study in Italy. Maturitas. 2000; 34(1):25-32. DOI: 10.1016/s0378-5122(99)00089-4. View

Bramlage P, Pittrow D, Wittchen H, Kirch W, Boehler S, Lehnert H . Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled. Am J Hypertens. 2004; 17(10):904-10. DOI: 10.1016/j.amjhyper.2004.05.017. View

Kuch B, Muscholl M, Luchner A, Doring A, Riegger G, Schunkert H . Gender specific differences in left ventricular adaptation to obesity and hypertension. J Hum Hypertens. 1998; 12(10):685-91. DOI: 10.1038/sj.jhh.1000689. View

10.

Schmieder R, Martus P, Klingbeil A . Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies. JAMA. 1996; 275(19):1507-13. View

11.

Nichols W, Denardo S, Davidson J, Huo T, Merz C, Pepine C . Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome.... Am Heart J. 2015; 170(6):1243-54. PMC: 4685957. DOI: 10.1016/j.ahj.2015.08.019. View

12.

Starling M . Left ventricular-arterial coupling relations in the normal human heart. Am Heart J. 1993; 125(6):1659-66. DOI: 10.1016/0002-8703(93)90756-y. View

13.

Redheuil A, Yu W, Mousseaux E, Harouni A, Kachenoura N, Wu C . Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J Am Coll Cardiol. 2011; 58(12):1262-70. PMC: 3508703. DOI: 10.1016/j.jacc.2011.06.012. View

14.

Sunagawa K, Maughan W, Burkhoff D, Sagawa K . Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol. 1983; 245(5 Pt 1):H773-80. DOI: 10.1152/ajpheart.1983.245.5.H773. View

15.

James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J . 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2013; 311(5):507-20. DOI: 10.1001/jama.2013.284427. View

16.

Liao Y, Cooper R, Mensah G, McGee D . Left ventricular hypertrophy has a greater impact on survival in women than in men. Circulation. 1995; 92(4):805-10. DOI: 10.1161/01.cir.92.4.805. View

17.

Klingbeil A, Schneider M, Martus P, Messerli F, Schmieder R . A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med. 2003; 115(1):41-6. DOI: 10.1016/s0002-9343(03)00158-x. View

18.

Crescioni M, Gorina Y, Bilheimer L, Gillum R . Trends in health status and health care use among older men. Natl Health Stat Report. 2010; (24):1-18. View

19.

Ong K, Cheung B, Man Y, Lau C, Lam K . Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2006; 49(1):69-75. DOI: 10.1161/01.HYP.0000252676.46043.18. View

20.

Kearney P, Whelton M, Reynolds K, Muntner P, Whelton P, He J . Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365(9455):217-23. DOI: 10.1016/S0140-6736(05)17741-1. View