Cardiac remodelling detected by imaging and circulating biomarkers in the general population associated with elevated blood pressure and hypertension
A Ohlrogge, E Unger, L E M Hannen, T Zeller, L Tilemann, P Schlieker, F Seum, A E Schutte, S Blankenberg, R B SchnabelAbstract
Background/Introduction
Hypertension (HTN) can cause end-organ damage to several organ systems, including the heart. The adverse cardiac effects of elevated blood pressure (eBP) are less well established.
Purpose
We aimed to understand the changes associated with eBP and HTN in a large-scale population-based cohort, detected by both imaging and circulating biomarkers.
Methods
Middle-aged adults from a population-based cohort study in Germany underwent standardized blood pressure measurements, in-depth transthoracic echocardiography and blood sampling. eBP and HTN were categorized according to the 2024 ESC guidelines. Linear regression models were performed, with standardized continuous dependent variables and multivariable adjustment for age, sex, smoking status, educational level, body mass index, logarithmic alcohol intake, heart rate, diabetes, total cholesterol, kidney disease, and a composite self-reported health status score derived from five domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), treated as a continuous variable.
Results
In total n=9,589 participants were available for this analysis (median age 63 years, 51% women). In multivariable-adjusted linear regression models, normal blood pressure was used as the reference category. Both eBP and HTN were significantly associated with several cardiac and biomarker variables, with generally larger effect sizes for HTN compared with eBP: A-wave velocity (Standard coefficient [β] 0.14, p=0.005 for eBP and β 0.15, p=0.004 for HTN), mitral valve E/A (β -0.24 and β -0.35, respectively, p<0.001 for both), IVSd (β 0.16 and β 0.32, respectively, p<0.001 for both) and left ventricular posterior wall diameter (β 0.11, p=0.018 and β 0.30, P<0.001, respectively). Some variables were statistically significantly associated only with hypertension, but not with elevated blood pressure: Median E/E’ (mean of lateral and medial) (β 0.07, p=0.19 for eBP and β 0.23, p<0.001 for HTN), left ventricular mass (β 0.05, p=0.21 and β 0.19, p<0.001, respectively) and logarithmic high-sensitive Troponin I (β 0.06, p=0.16 and β 0.20, p<0.001, respectively).
Conclusions
Both eBP and HTN are associated with cardiac remodelling including left ventricular hypertrophy, right ventricular function, atrial dilatation and diastolic dysfunction. Most of these changes gradually increase in their effect size from elevated blood pressure to hypertension. We demonstrate the adverse effects of eBP on cardiac dimension and function in a comprehensive, multimodal assessment in the largest population-based cohort published to date. This highlights the relevance of eBP as a serious condition capable of causing adverse end-organ damage in the general population.Figure 1 Baseline tableFor image description, please refer to the figure legend and surrounding text.Figure 2 Forest plotFor image description, please refer to the figure legend and surrounding text.