Elevated systolic blood pressure is associated with left ventricular remodelling in adults born preterm

1. In pre-term adults, an elevated systolic blood pressure was associated with left ventricular (LV) remodelling, including a greater LV mass index and greater LV mass to end-diastolic volume ratio.

2. The association between high blood pressure and LV remodelling was greater in adults born very pre-term (<32 weeks gestation) compared to those born moderately pre-term.

Evidence Rating Level: 2 (Good)

Study rundown: The link between preterm birth and an elevated risk of heart failure or ischemic heart disease is well established. This may be because the hearts of preterm born individuals are associated with cardiac remodelling, resulting in smaller internal left ventricle (LV) size and LV hypertrophy. As well, preterm individuals tend to experience higher blood pressure (BP), and are at greater risk of hypertension. The current study sought to investigate the association between systolic BP and LV structure/function, and whether this association varies by degree of prematurity. Blood pressure measurements and cardiac magnetic resonance imaging was done on a cohort of 468 adults: 51.5% women, >95% Caucasian, and 42.7% born preterm. As well, more than 25% were hypertensive, thereby addressing a limitation of previous studies (where inadequate numbers of hypertensive patients were enrolled). Overall, the study found a link between higher systolic BP and cardiac remodelling, represented by a greater LV mass index and greater LV mass to end-diastolic volume ratio. Furthermore, this association was more prominent in very preterm-born individuals (<32 weeks gestation) compared to moderately preterm individuals.

Click here to read the article in JAMA Cardiology

Relevant Reading:  Preterm Heart in Adult Life: Cardiovascular Magnetic Resonance Reveals Distinct Differences in Left Ventricular Mass, Geometry, and Function

In-Depth [prospective cohort]: All patients were adults aged 18 to 40 years old, with a BMI of less than 40, and with no history of cardiac and cerebrovascular disease, or treatment for hypertension. Of the 200 patients born preterm, 52.5% were moderately preterm (32-36 weeks gestation), 37.0% were very preterm (28-31 weeks), and 10.5% were extremely preterm (<28 weeks). Cardiac magnetic resonance imaging was done to analyze the volume, mass, and dimensions of the left ventricle. The results showed that adults born pre-term had reduced LV function, smaller LV volume, and higher LV mass index, compared to term-born individuals, regardless of hypertension status. For LV mass index, very and extremely pre-term born adults had a 2.5 times greater LV mass index for every 1-mm Hg increase in systolic BP (0.394 g/m² in pre-term, 0.157 g/m² in term-born; p < 0.001). This was 1.6 times greater for moderately pre-term born adults (0.250 g/m² vs 0.157 g/m²; p < 0.001). Additionally, the LV mass to end-diastolic volume ratio was 3.4 times greater for every 1-mm Hg increase in systolic BP, when comparing very and extremely pre-term individuals to moderately pre-term (3.56*10^-3 vs 1.04*10^-3 g/mL, p < 0.001), and 3.3 times greater when comparing very and extremely pre-term to term-born individuals (3.56*10^-3 vs 1.08*10^-3 g/mL, p < 0.001). Overall, elevated systolic blood pressure was associated with left ventricular remodelling, and to a greater extent in individuals born before 32 weeks gestation.

Image: PD

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