Study Of The Effect Of Longitudinal Strain On The Mechanical Changes Of The Left Ventricular Myocardium After Antihypertensive Treatment In Elderly Patients With Hypertension

Objective:Two-dimensional speckle tracking echocardiography(2D-STE)was used to study the effect of hypotensive therapy on left ventricular myocardial mechanics in elderly patients with primary hypertension,and to explore the changes in myocardial mechanics after antihypertensive hypotension in elderly hypertensive patients with different levels of myocardial mechanics at baseline,so as to provide clinical basis for the evaluation of cardiac function in elderly patients with hypertension.Methods:From January to June 2017,140 patients with primary elderly hypertension who were treated in Bethune Hospital Affiliated to Shanxi Medical University were selected,and their blood pressure was adjusted to the target value of elderly hypertension in China within 3months by drug antihypertensive therapy(130~150/(27)90mm Hg)and the treatment was maintained.After 24 months of antihypertensive therapy,12 cases who lost visits during antihypertensive treatment,failed to reach the blood pressure target or had poor image quality were excluded,and a total of 128 elderly hypertensive patients were included.28 elderly patients without cardiovascular disease were selected as the control group.Conventional left ventricular echocardiographic parameters and global longitudinal strain(GLS)of elderly hypertension and control groups were obtained at baseline.After sorting the GLS of elderly hypertension patients from smallest to largest at baseline,the elderly hypertensive patients were equally divided into group Q1(GLS:-13.2~-16.9;32 patients),group Q2(GLS:-17.0~-18.0;32 patients),group Q3(GLS:-18.1~-19.3;32 patients),and group Q4(GLS:-19.4~-21.2;32 patients).Echocardiography was performed to obtain conventional left ventricular ultrasound parameters and GLS after 12 and 24 months of antihypertensive treatment,respectively,to compare the changes of left ventricular ultrasound parameters in the baseline position and after 12 and 24 months of antihypertensive treatment in each group.Results:(1)At baseline,SBP and DBP of each group with hypertension were greater than the control group(all P(27)0.05).There was no statistically significant difference in disease duration,SBP and DBP between all groups of hypertension(all P>0.05).There were no statistically significant differences in age,gender,HR and BMI between the control and hypertensive groups(all P>0.05).(2)At baseline,IVSd,LVPWd,E/e’,LVMI,and RWT were greater in the hypertensive groups than in the control group,and GLS was less than in the control group(all P(27)0.05).The differences in conventional left ventricular ultrasound parameters among the hypertensive groups were not statistically significant(all P>0.05).There were no significant differences in LVEDD,LVESD,and LVEF between hypertension groups and control groups(all P>0.05).(3)After 12 and 24 months of antihypertensive treatment,the E/e’ decreased in all hypertensive groups compared with the baseline level(all P(27)0.05),and the differences in IVSd,LVPWd,LVEDD,LVESD,LVEF,LVMI,and RWT were not statistically significant compared with the baseline level(all P>0.05).(4)At baseline,CLS increased sequentially in groups Q1,Q2,Q3 and Q4(all P(27)0.05).After 12 and 24 months of antihypertensive treatment,GLS increased in all groups compared with baseline(all P(27)0.05).During 12 months of antihypertensive treatment,GLS improved more in all groups than from 12 to 24 months of antihypertensive treatment.After 12 and 24 months of antihypertensive treatment,from group Q1 to group Q4,the improvement of GLS decreased sequentially,that is,elderly hypertensive patients with low GLS levels at baseline had greater GLS improvement after antihypertensive treatment.Conclusion:(1)GLS decreased in patients with primary geriatric hypertension.(2)GIS improved in elderly hypertensive patients after 12 and 24 months of antihypertensive treatment,with a large improvement in GLS during 12 months period of antihypertensive treatment.(3)Elderly hypertensive patients with different baseline GLS levels had different degrees of GLS improvement after antihypertensive therapy,and those with severe GLS damage at baseline had a large degree of GLS improvement after antihypertensive therapy.