Uncontrolled blood pressure as an independent risk factor of early impaired left ventricular systolic function in treated hypertension

<jats:sec><jats:title>Background</jats:title><jats:p>Uncontrolled blood pressure (<jats:styled-content style="fixed-case">BP</jats:styled-content>) is commonly observed in patients receiving antihypertensive agents. However, its relationship with early left ventricular (<jats:styled-content style="fixed-case">LV</jats:styled-content>) dysfunction has not been elucidated.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study enrolled 276 patients with treated hypertension and 85 healthy controls. The 140/90 mm Hg was used to define controlled (<jats:styled-content style="fixed-case">HT</jats:styled-content>1 group, n=145) or uncontrolled <jats:styled-content style="fixed-case">BP</jats:styled-content> (<jats:styled-content style="fixed-case">HT</jats:styled-content>2 group, n=131) according to the concurrent guidelines. <jats:styled-content style="fixed-case">LV</jats:styled-content> myocardial function was assessed by two‐dimensional speckle tracking imaging, and the circumferential end‐systolic wall stress (<jats:styled-content style="fixed-case">cESS</jats:styled-content>)‐corrected mid‐wall fraction shortening (<jats:styled-content style="fixed-case">MWFS</jats:styled-content>), systolic longitudinal (εLs‐18), circumferential (εCs‐18), and radial (εRs‐18) strain were measured.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Despite similar ejection fraction, the <jats:styled-content style="fixed-case">HT</jats:styled-content>1 and <jats:styled-content style="fixed-case">HT</jats:styled-content>2 groups displayed an overall reduction in the <jats:styled-content style="fixed-case">cESS</jats:styled-content>‐corrected <jats:styled-content style="fixed-case">MWFS</jats:styled-content> (13.4±2.7 vs 11.7±1.7 vs 15.5±1.2), εLs‐18 (15.6±2.8 vs 13.0±2.2 vs 17.4±2.8), εCs‐18 (17.3±3.4 vs 14.1±2.7 vs 18.9±3.3), and εRs‐18 (18.4±4.0 vs 14.8±3.1 vs 20.5±4.5) %·cm<jats:sup>2</jats:sup>/kdyne·10<jats:sup>−2</jats:sup> when compared with the control group (all <jats:italic>P</jats:italic><.001). The changes were more obvious in the <jats:styled-content style="fixed-case">HT</jats:styled-content>2 group, regardless of <jats:styled-content style="fixed-case">LV</jats:styled-content> hypertrophy. Reductions in the <jats:styled-content style="fixed-case">cESS</jats:styled-content>‐corrected <jats:styled-content style="fixed-case">MWFS</jats:styled-content> and εLs‐18 were seen in 68 (25%) and 52 (19%) patients, respectively. Uncontrolled <jats:styled-content style="fixed-case">BP</jats:styled-content> were 4.365 times (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 2.203–8.648, <jats:italic>P</jats:italic><.001) and 3.928 times (1.851–8.337, <jats:italic>P</jats:italic><.001) more likely to be associated with the changes.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Uncontrolled <jats:styled-content style="fixed-case">BP</jats:styled-content> in hypertensive patients is associated with further reduction in <jats:styled-content style="fixed-case">LV</jats:styled-content> myocardial function detected by advanced echocardiographic techniques, which cannot be explained by the increase in afterload. It might be regarded as a composite risk factor for earlier and faster development of clinical heart failure, therefore, a simplified treatment target.</jats:p></jats:sec>