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Age attenuates the relationship between systolic blood pressure and left ventricular mass: evidence from the UK Biobank.

Session Hypertension - Heavy hearts, big problems

Speaker Nay Aung

Event : ESC Congress 2017

  • Topic : hypertension
  • Sub-topic : Hypertension
  • Session type : Advances in Science

Authors : N Aung (London,GB), MM Sanghvi (London,GB), F Zemrak (London,GB), JA Cooper (London,GB), JM Paiva (London,GB), RJ Thomson (London,GB), K Fung (London,GB), E Lukaschuk (Oxford,GB), A Lee (London,GB), V Carapella (Oxford,GB), YJ Kim (Oxford,GB), SK Piechnik (Oxford,GB), S Neubauer (Oxford,GB), SE Petersen (London,GB)

Authors:
N. Aung1 , M.M. Sanghvi1 , F. Zemrak1 , J.A. Cooper1 , J.M. Paiva1 , R.J. Thomson1 , K. Fung1 , E. Lukaschuk2 , A. Lee1 , V. Carapella2 , Y.J. Kim2 , S.K. Piechnik2 , S. Neubauer2 , S.E. Petersen1 , 1Queen Mary University of London, William Harvey Research Institute - London - United Kingdom , 2University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine - Oxford - United Kingdom ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 618

Introduction: Left ventricular (LV) hypertrophy is a recognised complication of arterial hypertension and associated with deleterious prognosis. Surveillance of LV hypertrophy with either electrocardiogram or an imaging modality is an important component of hypertension management. Both ageing and prolonged exposure to hypertension can induce diffuse fibrosis of myocardium and potentially modify the relationship between systolic blood pressure (SBP) and LV mass.

Purpose: The aim of this study was to investigate the influence of age on association between SBP and LV mass.

Methods: We analysed the data from 4,975 individuals from the UK Biobank, a large community-based cohort study. After excluding the participants with pre-existing self-reported cardiovascular disease defined as heart attack, heart failure, cardiomyopathy, valvular heart disease, stroke and peripheral vascular disease, 4,515 individuals remained. The left ventricular mass was measured from the short-axis, steady-state free precession cine images of cardiovascular magnetic resonance (CMR) studies. The brachial systolic blood pressure was measured using automatic Omron 705 IT electronic blood pressure monitor and an average of the two readings was taken. We performed univariate and multivariate linear regression to assess the association between SBP and LV mass. In multivariate model, we adjusted for age, gender, ethnicity, height, body mass index (BMI), average heart rate, average household income, Townsend deprivation index, educational attainment, job class, regular alcohol use, smoking status, hypertension diagnosis, presence of diabetes, respiratory disease, use of anti-hypertensive and lipid lowering medications and self-reported physical activity level as co-variates.

Results: The studied cohort was 61±8 years old and 46% male. The mean±SD of SBP and CMR-derived LV mass were 136±18mmHg and 89±24g, respectively. In univariate analysis, every 10mmHg increase in SBP was associated with 4.3g (95% CI 3.9 to 4.7g, p<10–16, adjusted R-squared 0.10) higher LV mass. In multivariate analysis, we observed 2.4g (95% CI 2.0 to 2.7g, p<10–16, adjusted R-squared 0.63) greater LV mass for every 10mmHg increment in SBP. Age was a significant effect modifier for the relationship between SBP and LV mass – every decade increase in age was associated with -0.9g (95% CI -1.4 to -4.2g, p for interaction = 0.0002) difference in LV mass per 10mmHg increase in SBP (Figure 1).

Conclusions: We confirmed a strong positive correlation between SBP and LV mass after adjusting for potential confounders in a large community-based cohort. The effect of SBP on LV mass was blunted by older age, possibly due to myocardial fibrosis from ageing and prolonged exposure to high blood pressure. This finding suggests that surveillance of LV hypertrophy alone for cardiac end-organ damage may not truly reflect the disease progression in the elderly.

Figure1. Influence of age

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