Characterizing the hypertensive cardiovascular phenotype in the UK Biobank
Characterizing the hypertensive cardiovascular phenotype in the UK Biobank
Aims: To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations. Methods and results: We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health record linkage. Associations between hypertension and CMR metrics were estimated using multivariable linear regression adjusting for major vascular risk factors. Stratified analyses were performed by sex, ethnicity, time since hypertension diagnosis, and blood pressure (BP) control. Results are standardized beta coefficients, 95% confidence intervals, and P-values corrected for multiple testing. Hypertension was associated with concentric left ventricular (LV) hypertrophy (increased LV mass, wall thickness, concentricity index), poorer LV function (lower global function index, worse global longitudinal strain), larger left atrial (LA) volumes, lower LA ejection fraction, and lower aortic distensibility. Hypertension was linked to significantly lower myocardial native T1 and increased LV ejection fraction. Women had greater hypertension-related reduction in aortic compliance than men. The degree of hypertension-related LV hypertrophy was greatest in Black ethnicities. Increasing time since diagnosis of hypertension was linked to adverse remodelling. Hypertension-related remodelling was substantially attenuated in hypertensives with good BP control. Conclusion: Hypertension was associated with concentric LV hypertrophy, reduced LV function, dilated poorer functioning LA, and reduced aortic compliance. Whilst the overall pattern of remodelling was consistent across populations, women had greater hypertension-related reduction in aortic compliance and Black ethnicities showed the greatest LV mass increase. Importantly, adverse cardiovascular remodelling was markedly attenuated in hypertensives with good BP control.
antihypertensive therapies, cardiovascular magnetic resonance, ethnicity, population health, women's health
1352-1360
Elghazaly, Hussein
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McCracken, Celeste
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Szabo, Liliana
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Malcomson, James M.
ebfa3cb7-df61-4a68-93e3-4f1882f7e9a8
Manisty, Charlotte H
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Davies, Alun H
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Piechnik, Stefan K.
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Harvey, Nicholas
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Neubauer, Stefan
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Mohiddin, Saidi A.
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Petersen, Steffen E.
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Raisi-Estabragh, Zahra
43c85c5e-4574-476b-80d6-8fb1cdb3df0a
1 October 2023
Elghazaly, Hussein
49789d64-cca4-41d0-97f6-81849c49719a
McCracken, Celeste
5d772e9e-3aaa-41da-a5ef-3943b1631fd9
Szabo, Liliana
a5da4e9d-450f-43e5-b2de-1b1cabde6a6c
Malcomson, James M.
ebfa3cb7-df61-4a68-93e3-4f1882f7e9a8
Manisty, Charlotte H
7965f8f5-350d-4d57-9bdb-8a0bb5f9aa8d
Davies, Alun H
72a8fb35-1971-4a69-9a60-b0fb3ad46d8c
Piechnik, Stefan K.
7de3d548-ca5a-40cb-a52b-c53d2dd2278a
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Neubauer, Stefan
c8a34156-a4ed-4dfe-97cb-4f47627d927d
Mohiddin, Saidi A.
844ce254-44f0-464a-b25f-0f6eb721d62b
Petersen, Steffen E.
04f2ce88-790d-48dc-baac-cbe0946dd928
Raisi-Estabragh, Zahra
43c85c5e-4574-476b-80d6-8fb1cdb3df0a
Elghazaly, Hussein, McCracken, Celeste, Szabo, Liliana, Malcomson, James M., Manisty, Charlotte H, Davies, Alun H, Piechnik, Stefan K., Harvey, Nicholas, Neubauer, Stefan, Mohiddin, Saidi A., Petersen, Steffen E. and Raisi-Estabragh, Zahra
(2023)
Characterizing the hypertensive cardiovascular phenotype in the UK Biobank.
European Heart Journal - Cardiovascular Imaging, 24 (10), , [jead123].
(doi:10.1093/ehjci/jead123).
Abstract
Aims: To describe hypertension-related cardiovascular magnetic resonance (CMR) phenotypes in the UK Biobank considering variations across patient populations. Methods and results: We studied 39 095 (51.5% women, mean age: 63.9 ± 7.7 years, 38.6% hypertensive) participants with CMR data available. Hypertension status was ascertained through health record linkage. Associations between hypertension and CMR metrics were estimated using multivariable linear regression adjusting for major vascular risk factors. Stratified analyses were performed by sex, ethnicity, time since hypertension diagnosis, and blood pressure (BP) control. Results are standardized beta coefficients, 95% confidence intervals, and P-values corrected for multiple testing. Hypertension was associated with concentric left ventricular (LV) hypertrophy (increased LV mass, wall thickness, concentricity index), poorer LV function (lower global function index, worse global longitudinal strain), larger left atrial (LA) volumes, lower LA ejection fraction, and lower aortic distensibility. Hypertension was linked to significantly lower myocardial native T1 and increased LV ejection fraction. Women had greater hypertension-related reduction in aortic compliance than men. The degree of hypertension-related LV hypertrophy was greatest in Black ethnicities. Increasing time since diagnosis of hypertension was linked to adverse remodelling. Hypertension-related remodelling was substantially attenuated in hypertensives with good BP control. Conclusion: Hypertension was associated with concentric LV hypertrophy, reduced LV function, dilated poorer functioning LA, and reduced aortic compliance. Whilst the overall pattern of remodelling was consistent across populations, women had greater hypertension-related reduction in aortic compliance and Black ethnicities showed the greatest LV mass increase. Importantly, adverse cardiovascular remodelling was markedly attenuated in hypertensives with good BP control.
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jead123
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Accepted/In Press date: 22 May 2023
e-pub ahead of print date: 13 June 2023
Published date: 1 October 2023
Additional Information:
Funding Information:
C.M. and S.N. were supported by the Oxford NIHR Biomedical Research Centre (IS-BRC-1215–20 008) and S.N. by the Oxford British Heart Foundation Centre of Research Excellence. C.H.M. is supported directly and indirectly from the NIHR Biomedical Research Centres at University College London Hospitals and Barts Health NHS Trusts. N.C.H. acknowledges support from MRC (MC_PC_21003; MC_PC_21001) and NIHR Southampton Biomedical Research Centre. This project was enabled through access to the MRC eMedLab Medical Bioinformatics infrastructure, supported by the Medical Research Council ( www.mrc.ac.uk ; MR/L016311/1). S.N. and S.E.P. acknowledge the British Heart Foundation for funding the manual analysis to create a cardiovascular magnetic resonance imaging reference standard for the UK Biobank imaging-resource in 5000 CMR scans ( www.bhf.org.uk ; PG/14/89/31194). S.E.P. acknowledges support from the ‘SmartHeart’ EPSRC programme grant ( www. nihr.ac.uk ; EP/P001009/1) and also from the CAP-AI programme, London's first AI enabling programme focused on stimulating growth in the capital's AI Sector. CAP-AI is led by Capital Enterprise in partnership with Barts Health NHS Trust and Digital Catapult and is funded by the European Regional Development Fund and Barts Charity. S.E.P. and L.S. have received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 825903 (euCanSHare project). Z.R.-E. recognizes the National Institute for Health Research (NIHR) Integrated Academic Training programme which supports her Academic Clinical Lectureship post and was also supported by British Heart Foundation Clinical Research Training Fellowship No. FS/17/81/33318.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
Keywords:
antihypertensive therapies, cardiovascular magnetic resonance, ethnicity, population health, women's health
Identifiers
Local EPrints ID: 477519
URI: http://eprints.soton.ac.uk/id/eprint/477519
ISSN: 2047-2404
PURE UUID: d5870a60-a3ff-4e31-aa75-5c2831f31a8e
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Date deposited: 07 Jun 2023 17:09
Last modified: 17 Mar 2024 02:59
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Contributors
Author:
Hussein Elghazaly
Author:
Celeste McCracken
Author:
Liliana Szabo
Author:
James M. Malcomson
Author:
Charlotte H Manisty
Author:
Alun H Davies
Author:
Stefan K. Piechnik
Author:
Stefan Neubauer
Author:
Saidi A. Mohiddin
Author:
Steffen E. Petersen
Author:
Zahra Raisi-Estabragh
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