Abstract
Introduction: Hypertension, one of the most modifiable risk factors of heart disease, induces cardiac remodeling and worsens myocardial function prior to the development of clinical symptoms. Using a comprehensive cohort of Hispanic/Latino adults, we assessed cardiac structure and function, in relation to hypertension, and the longitudinal impact of blood pressure control. Hypothesis: If baseline hypertensive adults are stratified by longitudinal blood pressure (BP) control, there will be differences in the progression of cardiac structure and function parameters. Methods: The Echo-SOL Ancillary Study provided serial comprehensive echocardiographic assessments of Hispanic adults aged 45-74 years. They were arranged into two groups based on the presence of baseline hypertension (>140/90mmHg). Linear regression models were used to estimate the association between baseline BP properties and the longitudinal change in echocardiogram parameters. We then subdivided each group based on whether the they maintained BP control (<140/90mmHg) on follow up and used linear regression models to test for significance among the mean longitudinal change of echocardiogram parameters. All analyses accounted for the complex sampling design of HCHS/SOL and Echo-SOL. Results: There was a total of 1818 adults at baseline, with 1643 obtaining serial echocardiograms an average of 4.3 years later, mean age of approximately 56 years. Among all adults, baseline pulse pressure was significantly associated with a longitudinal increase in left ventricular (LV) end diastolic volume (β=0.13, p=0.02), whereas the change in LV mass index longitudinally decreased with baseline diastolic BP (β=-0.14, p<0.01). When isolating the subgroup defined as hypertensive at baseline, the adults who had uncontrolled BP on follow up had a greater absolute increase in the average E/E’ ratio and greater decrease in average E’ velocity, 0.95±0.08 and -0.96±0.06 respectively, compared to the adults with controlled BP 0.04±0.07 and -0.74± 0.04 respectively (p<0.01). In addition, the controlled BP group had a greater absolute reduction in LV end-diastolic volume of 6.94mL than those with uncontrolled BP, 4.60mL (p<0.01). Conclusions: Our study is the first to study the association of longitudinal impact of blood pressure control with cardiac structure and function in Hispanic/Latino adults. We found that higher baseline brachial BP properties were associated with reduced in LV mass index and increased LV end diastolic volumes. Among the baseline hypertensive adults, there was a significantly higher progression in diastolic dysfunction among the participants who had poor BP control, but those with controlled BP on follow up had greater LV enlargement. Despite these differences, both subgroups ultimately showed a collective progression in diastolic dysfunction and a decrease in end-diastolic volume over time.