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

doi:10.1097/GME.0000000000001046

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

Kinesiology and Health Promotion

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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 ² ), but it was lower in the normotensive group (41.7 ± 0.9 g/m ² ; 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/cm ⁵ ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm ⁵ ) 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 language	English
Pages (from-to)	554-562
Number of pages	9
Journal	Menopause
Volume	25
Issue number	5
DOIs	https://doi.org/10.1097/GME.0000000000001046
State	Published - May 1 2018

Bibliographical note

Funding Information:
Received August 14, 2017; revised and accepted November 7, 2017. From the 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX; and 2The University of Texas Southwestern Medical Center, Dallas, TX. Funding/support: Supported by NIH R01 HL091078 grant. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Qi Fu, MD, PhD, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231-8205. E-mail: FuQi@texashealth.org

Publisher Copyright:
© 2017 by The North American Menopause Society.

Keywords

Arterial load
Controlled hypertension
Older women
Uncontrolled hypertension
Ventricular hypertrophy

ASJC Scopus subject areas

Obstetrics and Gynecology

Access to Document

10.1097/GME.0000000000001046

Cite this

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title = "Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension",

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 2 ), but it was lower in the normotensive group (41.7 ± 0.9 g/m 2 ; 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/cm 5 ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm 5 ) 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.",

keywords = "Arterial load, Controlled hypertension, Older women, Uncontrolled hypertension, Ventricular hypertrophy",

author = "Yoo, {Jeung Ki} and Yoshiyuki Okada and Best, {Stuart A.} and Parker, {Rosemary S.} and Michinari Hieda and Levine, {Benjamin D.} and Qi Fu",

note = "Funding Information: Received August 14, 2017; revised and accepted November 7, 2017. From the 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX; and 2The University of Texas Southwestern Medical Center, Dallas, TX. Funding/support: Supported by NIH R01 HL091078 grant. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Qi Fu, MD, PhD, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231-8205. E-mail: FuQi@texashealth.org Publisher Copyright: {\textcopyright} 2017 by The North American Menopause Society.",

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AU - Yoo, Jeung Ki

AU - Okada, Yoshiyuki

AU - Best, Stuart A.

AU - Parker, Rosemary S.

AU - Hieda, Michinari

AU - Levine, Benjamin D.

AU - Fu, Qi

N1 - Funding Information: Received August 14, 2017; revised and accepted November 7, 2017. From the 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX; and 2The University of Texas Southwestern Medical Center, Dallas, TX. Funding/support: Supported by NIH R01 HL091078 grant. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Qi Fu, MD, PhD, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231-8205. E-mail: FuQi@texashealth.org Publisher Copyright: © 2017 by The North American Menopause Society.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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 2 ), but it was lower in the normotensive group (41.7 ± 0.9 g/m 2 ; 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/cm 5 ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm 5 ) 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.

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/m 2 ), but it was lower in the normotensive group (41.7 ± 0.9 g/m 2 ; 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/cm 5 ), whereas controlled HTN group (1925 ± 527 dyn∗s/cm 5 ) 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.

KW - Arterial load

KW - Controlled hypertension

KW - Older women

KW - Uncontrolled hypertension

KW - Ventricular hypertrophy

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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