Long-term antihypertensive therapy beneficial for myocardial strain

Antihypertensive treatment provides benefits on left ventricular (LV) mechanisms, suggest the results of a meta-analysis, noting that improvement in global longitudinal strain (GLS) is associated with the reduction in LV mass index (LVMI) instead of systolic blood pressure (SBP).

A team of investigators conducted a meta-analysis of speckle-tracking echocardiographic studies after searching the databases of PubMed, Ovid-Medline, and Cochrane Library for articles published from inception up to 31 October 2021.

They identified studies by using MeSH terms and crossing the following search items: ‘myocardial strain’, ‘left ventricular mechanics’, ‘speckle tracking echocardiography’, ‘systolic dysfunction’, ‘left ventricular hypertrophy’, ‘systemic hypertension’, ‘BP lowering drugs,’ and ‘antihypertensive therapy’.

Eight studies met the eligibility criteria and included a total of 1,140 hypertensive patients (mean age 55.4 years, 50 percent men, follow-up 6‒36 months). Pre- and post-treatment pooled SBP/diastolic BPs were 148.4/88.7 mm Hg vs 127.4/77.8 mm Hg, respectively.

The corresponding values were 64 percent vs 65.9 percent (standardized mean difference [SMD], 0.14, 95 percent confidence interval [CI], 0.08‒0.20; p=0.001) for ejection fraction, 108.4 vs 100.2 g/m² (SMD, −0.27, 95 percent CI −0.46 to −0.08; p<0.01) for LVMI, and −17.7 percent vs −19.6 percent, (SMD, 0.26, 95 percent CI, 0.20–0.32; p<0.0001) for GLS.

Furthermore, a meta-regression analysis revealed a significant association between GLS improvement and the extent of reduction of LVMI (p=0.0003) but not of SBP (p=0.27).