Ignatios Ikonomidis, MD, PhD, University of Athens Medical School, Attikon Hospital, Athens, Greece, presented results of a 3-year follow-up study, which demonstrated that long-term antihypertensive treatment improved the twist and untwist mechanics of the left ventricle in patients with hypertension, in addition to reducing blood pressure (BP), left ventricular (LV) mass, and arterial stiffness.

According to Prof Ikonomidis, LV function in patients with hypertension is determined by factors such as BP, arterial stiffness, LV mass, and coronary microcirculation. With this in mind, the researchers conducted a study to investigate the long-term effects of antihypertensive treatment on these parameters in this patient population.

The study enrolled 75 untreated patients (mean age, 54 ± 11 years) with essential hypertension and 50 healthy control participants of a similar age and sex distribution. All patients with hypertension were treated with angiotensin receptor blockers, and characterized as having well-controlled BP if their 24-hour systolic and diastolic BP were < 130/80 mm Hg.

At baseline and after 3-year follow-up, 24-hour ambulatory BP monitoring was performed in all study participants. Additional parameters were also assessed using conventional and speckle tracking echocardiography, including: carotid to femoral artery pulse wave velocity (PWV); coronary flow reserve (CFR) after adenosine infusion; LV mass/in², twisting (Tw); peak Tw velocity; untwisting at the mitral valve opening (unTwMVO), at the peak of the E wave (unTwE), and at the end of the E wave (unTwendE) of the mitral inflow; and untwisting (unTw) velocity.

Prof Ikonomidis explained that since LV torsional dynamics are sensitive markers of LV function, short-axis 2D images were analyzed for LV torsion, which was defined as the difference in rotation between the basal and apical planes.

Compared with control participants, those with hypertension had lower CFR (2.5 ± 0.6 vs 2.9 ± 0.6) and higher PWV (9.2 ± 1.5 vs 11.7 ± 2 m/s), Tw (13 ± 4 vs 20 ± 4 degrees), Tw velocity (89 ± 21 vs 126 ± 38 deg/s), unTwMVO (8.8 ± 3.2 vs 15.7 ± 5 degrees), unTwE (5.8 ± 3.1 vs 10 ± 5 degrees), unTwendE (2.2 ± 2.1 vs 5.8 ± 4 degrees), unTw velocity (−93 ± 31 vs −104 ± 37 deg/s), LV mass/m² (70.7 ± 14 vs 81 ± 16), and BP (P < .01 for all comparisons).

After 3 years of antihypertensive treatment, BP was well controlled in 70% of the patients with hypertension. Compared with baseline, these patients had reduced PWV (11.7 ± 2 vs 10.8 ± 1.5 m/s), Tw (20 ± 4 vs 15 ± 4 degrees), Tw velocity (126 ± 38 vs 110 ± 21 deg/s), unTwMVO (15.7 ± 4 vs 10.5 ± 4 degrees), unTwE (10.5 ± 4 vs 7.2 ± 4 degrees), unTwendE (5.8 ± 4 vs 3.9 ± 4 degrees), unTw velocity (−104 ± 37 vs −94 ± 31 deg/s), LV mass/m² (81 ± 16 vs 75 ± 16), and 24-hour BP (systolic 138 ± 10 vs 123 ± 14 mm Hg; and diastolic 87 ± 9 vs 75 ± 8 mm Hg; P < .05 for all comparisons). However, CFR remained similar (2.5 ± 0.6 vs 2.5 ± 0.9).

Prof Ikonomidis therefore concluded that long-term antihypertensive treatment improves LV twisting and untwisting in patients with essential hypertension, concomitant with reductions in BP, LV mass, and arterial stiffness.