Prevalence and Associated Factors of Mitral Regurgitation in Severe Hypertension: A Cross-Sectional Echocardiographic Study

ABSTRACT Background. Severe hypertension increases the odds of having hypertensive target organ lesions, including mitral regurgitation (MR) which is associated with excess mortality rates. We aimed to determine the prevalence and determinants of MR in severe hypertensives. Materials and Methods. We included 92 patients with severe hypertension in this cross-sectional study conducted in two tertiary hospitals in Yaounde. After informed consent, clinical and echocardiographic data were collected. Echocardiographic assessment was performed as recommend by European society of cardiology guidelines on cardiovascular imaging. Proportion were compared with the Chi square or the Fisher exact test, with a significance threshold of 5%. Results. The mean age of participants was 60.8 ± 13.1 years. MR was found in 20.7% (95% CI: 13 – 29.3) of patients. Systolic blood pressure ≥ 200 mmHg (p = 0.037), diastolic blood pressure ≥ 126 mmHg (p = 0.019), left ventricular dilation (p = 0.018), angiotensin converting enzyme inhibitors (ACEs) treatment (p = 0.037) and left ventricular ejection fraction (LVEF) \u003c 50 % (p = 0.001) were significantly associated with MR. After adjustment for potential confounders, ACEs and LVEF \u003c 50% remained associated with MR. Conclusion. MR is common in patients with severe hypertension and is associated with higher blood pressure, ACEs treatment, left ventricular dilation and ejection fraction impairment. Early echocardiographic assessment of patients with severe hypertension may contribute to improvement of their outcome. RESUME Contexte. L’hypertension arterielle (HTA) severe predispose aux lesions d’organes cibles chez les patients concernes, y compris a la regurgitation mitrale (RM) qui, associee a une HTA severe majore les taux de mortalite. Le but de notre travail etait de determiner la prevalence et les determinants de la RM chez les patients presentant une HTA severe. Methodes. Il s’agissait d’une etude transversale bi centrique (Hopital central de Yaounde et Hopital General de Yaounde). Apres obtention d’un consentement libre et eclaire, les donnees cliniques et echocardiographiques ont ete recueillies. L’evaluation echocardiographique a ete effectuee selon les lignes directrices de la Societe Europeenne de Cardiologie La proportion a ete comparee au carre Chi ou au critere exact de Fisher, avec un seuil de significativite de 5 %. Resultats. Nous avons inclus 92 patients presentant une HTA severe. L’âge moyen des participants etait de 60,8 ± 13,1 ans. La RM a ete retrouvee chez 20,7% (IC 95% : 13 – 29.3) des patients. Les parametres tels que la pression arterielle systolique (PAS) ≥ 200 mmHg (p = 0,037), pression arterielle diastolique (PAD) ≥ 126 mmHg (p = 0,019), dilatation ventriculaire gauche (p = 0,018), le traitement par des inhibiteurs de l’enzyme de conversion de l’angiotensine (IEC) (p = 0,037) et la fraction d’ejection ventriculaire gauche (FEVG) \u003c 50 % (p = 0,001) ont ete significativement associes a la RM. Apres ajustement, la therapeutique par les IEC et la FEVG \u003c 50% sont restes associes a la RM. Conclusion. la RM est retrouvee chez les patients ayant une HTA severe et est associe a une pression arterielle plus elevee, le traitement par les IEC, la dilatation ventriculaire gauche et la diminution de la fraction d’ejection. Une evaluation echocardiographique precoce chez ces patients pourrait contribuer a l’amelioration de leur prise en charge.