Ps-c20-11: antihypertensive treatment improves left ventricular diastolic function and indices of arterial stiffness in younger men with grade 1 hypertension

Background: Hypertension is a major risk factor for diastolic dysfunction which, once established, is essentially irreversible. However, it is unclear whether early manifestations of diastolic dysfunction in younger people with mild hypertension can improve with antihypertensive treatment. Objectives: Evaluate whether one-year antihypertensive treatment in younger men (age < 55 years) with low-risk (no evidence of hypertension mediated organ damage) grade 1 hypertension improves diastolic function and indices of arterial stiffness. Methods: 105 treatment-naive men (mean age: 47 ± 6 years) with grade 1 hypertension (confirmed on ABPM) were recruited. Patients were randomised using a PROBE design to one-year antihypertensive treatment (ARB and/or CCB) or no treatment (control). Cardiac function was assessed at baseline and study end via 1.5-Tesla cMRI (MAGNETOM Avanto; Siemens Healthineers AG, Germany) using prospectively gated mid-left-ventricular golden angle tissue phase mapping (primary outcome). Arterial stiffness was measured using CAVI device (VS-1500N; Fukuda Denshi, Japan). Results: Diastolic (longitudinal E/A ratio) and systolic (longitudinal S peak velocity) function improved with treatment (n = 38; 0.11 ± 0.24 and 0.38 ± 1.19 cm.s −1 , P = 0.01 and 0.05, respectively) but deteriorated in the control group (n = 44; -0.06 ± 0.33 and -0.13 ± 1.12 cm.s −1 , P = 0.01 and 0.05, respectively). Improvement in diastolic function was significantly influenced by baseline bodyfat % and BMI (20 ± 8 versus 27 ± 10%, P = 0.04 and 27.8 ± 3.4 versus 31.0 ± 5.3 kg.m −2 , P = 0.03, respectively). CAVI pre-ejection period (-9 ± 15 versus 1 ± 13 ms, P = 0.006), pre-ejection-period.ejection-time −1 (-0.03 ± 0.06 versus 0.00 ± 0.05, P = 0.02), upstroke time (-33 ± 50 versus -8 ± 45 ms, P = 0.03), pulse wave velocity (-0.89 ± 0.64 versus -0.02 ± 0.64 m.s −1 , P < 0.001), CAVI (-0.40 ± 0.65 versus 0.03 ± 0.62, P = 0.005) and CAVI estimated vascular age (-3 ± 7 versus 1 ± 7 years old, P = 0.02) all improved with TREATMENT (n = 40) versus CONTROL (n = 44). Conclusions: Early treatment of Grade 1 hypertension improves left ventricular diastolic function. Treated patients with E/A improvements were leaner, which highlights the importance of a healthy lifestyle. Treatment also improved arterial stiffness, however it is unclear whether those changes were predominantly structural and/or functional. Further work is warranted to establish whether an even earlier intervention is needed to restore diastolic function to the level of normotensive age-matched controls.