Cardiovascular and haemodynamic changes in resistant hypertension: relation to blood pressure control in a longitudinal study

Cardiovascular alterations and autonomic nervous abnormality exist in patients with resistant hypertension (RH) (1, 2). The effects of optimised antihypertensive treatment on cardiac, vascular and autonomic system are well-documented in essential hypertension. However, less is known about antihypertensive treatment optimisation on cardiovascular and autonomic function in the RH population.

Cardiac haemodynamics, strain function, vascular (brachial artery flow-mediated dilation, (FMD); pulse wave velocity, (PWV)) and autonomic functions (heart rate variability, (HRV)) were evaluated in patients with confirmed RH (n=17, mean age 58 years). The patients were followed up after eight weeks of optimised antihypertensive treatment to assess the changes in myocardial mechanics, vascular function and autonomic function.

Following eight weeks of optimised antihypertensive treatment (Table 1), global longitudinal strain (GLS) and global circumferential strain (GCS) improved in RH group (GLS -17±1.5% vs. -19±2.8%, p=0.002; GCS -29.7±4.3% vs. -31.1±5.4%, p=0.04). FMD showed significant improvement (6.7±3 vs 5.3±3%, p=0.04). There were no significant changes in central systolic blood pressure (BP) (154 [139-193] mmHg vs. 177 [159-193] mmHg, p=0.11), central diastolic BP (82±20 mmHg vs 87±15 mmHg, p=0.28); PWV (9.3 [8-11] m/s vs. 9.8 [8-11] m/s, p=0.81); SDNN (p=0.16), rMSSD (p=0.28), pNN50 (p=0.42), and LF/HF (p=0.98), HRV (p=0.08), LF normalised (p=0.71), and log (LF/HF) (p=0.73).

After 8 weeks of antihypertensive treatment, cardiac strain function, endothelial function and 24h BP significantly improved compared with baseline in patients with true RH; however, arterial stiffness did not significantly change.

Changes of cardiovascular and autonomic