Prevalence and Associated Factors of Mitral Regurgitation in Severe Hypertension: A Cross-Sectional Echocardiographic Study

Chris Nadège Nganou–Gnindjio, Jerome Boombhi, Guy Sadeu Wafeu, Larissa Ndengue Ebogo, Françoise Estelle Ndongo Owona, Samuel Kingue

Abstract


ABSTRACT
Background. Severe hypertension increases the odds of having hypertensive target organ lesions, including mitral regurgitation (MR) which is associated with excess mortality rates. We aimed to determine the prevalence and determinants of MR in severe hypertensives. Materials and Methods. We included 92 patients with severe hypertension in this cross-sectional study conducted in two tertiary hospitals in Yaoundé. After informed consent, clinical and echocardiographic data were collected. Echocardiographic assessment was performed as recommend by European society of cardiology guidelines on cardiovascular imaging. Proportion were compared with the Chi square or the Fisher exact test, with a significance threshold of 5%. Results. The mean age of participants was 60.8 ± 13.1 years. MR was found in 20.7% (95% CI: 13 – 29.3) of patients. Systolic blood pressure ≥ 200 mmHg (p = 0.037), diastolic blood pressure ≥ 126 mmHg (p = 0.019), left ventricular dilation (p = 0.018), angiotensin converting enzyme inhibitors (ACEs) treatment (p = 0.037) and left ventricular ejection fraction (LVEF) < 50 % (p = 0.001) were significantly associated with MR. After adjustment for potential confounders, ACEs and LVEF < 50% remained associated with MR. Conclusion. MR is common in patients with severe hypertension and is associated with higher blood pressure, ACEs treatment, left ventricular dilation and ejection fraction impairment. Early echocardiographic assessment of patients with severe hypertension may contribute to improvement of their outcome.
RÉSUMÉ
Contexte. L’hypertension artérielle (HTA) sévère prédispose aux lésions d’organes cibles chez les patients concernés, y compris à la régurgitation mitrale (RM) qui, associée à une HTA sévère majore les taux de mortalité. Le but de notre travail était de déterminer la prévalence et les déterminants de la RM chez les patients présentant une HTA sévère. Méthodes. Il s’agissait d’une étude transversale bi centrique (Hôpital central de Yaoundé et Hôpital Général de Yaoundé). Après obtention d’un consentement libre et éclairé, les données cliniques et échocardiographiques ont été recueillies. L’évaluation échocardiographique a été effectuée selon les lignes directrices de la Société Européenne de Cardiologie La proportion a été comparée au carré Chi ou au critère exact de Fisher, avec un seuil de significativité de 5 %. Résultats. Nous avons inclus 92 patients présentant une HTA sévère. L’âge moyen des participants était de 60,8 ± 13,1 ans. La RM a été retrouvée chez 20,7% (IC 95% : 13 – 29.3) des patients. Les paramètres tels que la pression artérielle systolique (PAS) ≥ 200 mmHg (p = 0,037), pression artérielle diastolique (PAD) ≥ 126 mmHg (p = 0,019), dilatation ventriculaire gauche (p = 0,018), le traitement par des inhibiteurs de l’enzyme de conversion de l’angiotensine (IEC) (p = 0,037) et la fraction d’éjection ventriculaire gauche (FEVG) < 50 % (p = 0,001) ont été significativement associés à la RM. Après ajustement, la thérapeutique par les IEC et la FEVG < 50% sont restés associés à la RM. Conclusion. la RM est retrouvée chez les patients ayant une HTA sévère et est associé à une pression artérielle plus élevée, le traitement par les IEC, la dilatation ventriculaire gauche et la diminution de la fraction d’éjection. Une évaluation échocardiographique précoce chez ces patients pourrait contribuer à l’amélioration de leur prise en charge.

 


Keywords


Mitral regurgitation; Severe hypertension; 2D-Echocardiography; Cameroon.

Full Text:

PDF

References


World Health Organization (WHO). Hypertension. Fact sheets. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension .

Kuate Defo B, Mbanya JC, Kingue S, Tardif J-C, Choukem SP, Perreault S, et al. Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies. J Hypertens. nov 2019;37(11):2190‑9.

Borzecki AM, Kader B, Berlowitz DR. The epidemiology and management of severe hypertension. J Hum Hypertens. janv 2010;24(1):9‑18.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertensionThe Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 1 sept 2018;39(33):3021‑104.

Dziadzko V, Clavel M-A, Dziadzko M, Medina-Inojosa JR, Michelena H, Maalouf J, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet. 10 mars 2018;391(10124):960‑9.

Lindmark K, Söderberg S, Teien D, Näslund U. Long-term follow-up of mitral valve regurgitation—Importance of mitral valve pathology and left ventricular function on survival. International Journal of Cardiology. 1 oct 2009;137(2):145‑50.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. janv 2018;41(Supplement 1):S13‑27.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. avr 2016;29(4):277‑314.

Rahimi K, Mohseni H, Otto CM, Conrad N, Tran J, Nazarzadeh M, et al. Elevated blood pressure and risk of mitral regurgitation: A longitudinal cohort study of 5.5 million United Kingdom adults. PLoS Med. 14(10).

Oladapo O, Salako L, Sadiq L, Shoyinka K, Adedapo K, Falase A. Target-organ damage and cardiovascular complications in hypertensive Nigerian Yoruba adults: a cross-sectional study. Cardiovasc J Afr. août 2012;23(7):379‑84.

Douedi S, Douedi H. Mitral Regurgitation. 2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31985928.

Jones EC, Devereux RB, Roman MJ, Liu JE, Fishman D, Lee ET, et al. Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). Am J Cardiol. 1 févr 2001;87(3):298‑304.

Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: Update and review. Glob Cardiol Sci Pract. 2017(1).

Strauss CE, Duval S, Pastorius D, Harris KM. Pharmacotherapy in the treatment of mitral regurgitation: a systematic review. J Heart Valve Dis. mai 2012;21(3):275‑85.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

********************************************************************************************