Effect of long-term antihypertensive therapy on myocardial strain: a meta-analysis

Aim: Evidence on the impact of blood pressure (BP)-lowering drugs on left ventricular (LV) mechanics in hypertension is still limited. We performed a meta-analysis of speckle-tracking echocardiographic studies in order to provide a new piece of information on this topic. Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to 31 October 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular hypertrophy', 'systemic hypertension', 'BP lowering drugs,' 'antihypertensive therapy'. Results: A total of 1140 hypertensive patients (mean age 55.4 years, 50% men, follow-up 6-36 months) were included in eight studies. Pretreatment and posttreatment pooled SBP/DBPs were 148.4 +/- 3.5/88.7 +/- 2 vs. 127.4 +/- 1.9/77.8 +/- 0.9 mmHg. Corresponding values for ejection fraction (EF), LV mass (LVM) index, and global longitudinal strain (GLS) were 64 +/- 2.3 vs. 65.9 +/- 1.7% (SMD: 0.14 +/- 0.03, CI 0.08- 0.20, P = 0.001); 108.4 +/- 11.2 vs. 100.2 +/- 11.0 g/m(2) (SMD: -0.27 +/- 0.10, CI -0.46 to -0.08, P < 0.01); -17.7 +/- 0.6 vs. -19.6 +/- 0.4%, (SMD 0.26 +/- 0.03, CI 0.20-0.32, P < 0.0001), respectively. A meta-regression analysis showed a significant relation between GLS improvement and the extent of reduction of LVMI (P = 0.0003), but not of SBP (P = 0.27). Conclusion: Our meta-analysis suggests that antihypertensive treatment has a clear beneficial effect on LV mechanisms, and the improvement in GLS is mainly related to the reduction in LVMI rather than SBP.