TOPLINE

Among patients with hypertrophic cardiomyopathy (HCM), concomitant hypertension showed a greater burden of myocardial fibrosis on cardiac imaging and was associated with a 32% higher risk for all-cause mortality over a median follow-up duration of 9 years; however, a higher extent of late gadolinium enhancement (LGE) and the septal location of LGE remained independent predictors of death regardless of hypertension status.

METHODOLOGY

• Drawing on data from a large retrospective registry of consecutive patients with HCM who underwent cardiac MRI between 2008 and 2024, researchers characterised the imaging phenotype associated with concomitant hypertension and examined its relationship with all-cause mortality.
• The study included 2873 patients with HCM (mean age, 52 years; 56% men), of whom 796 had hypertension and 2077 did not.
• Propensity score matching was performed to balance baseline differences between patients with and without hypertension, resulting in a matched cohort of 1550 patients (775 in each group).
• The primary outcome was all-cause mortality, and the secondary outcome was cardiac mortality. Patients were followed up for a median of 9 years.
• The researchers assessed cardiovascular magnetic resonance-derived biomarkers, including the extent, location, and pattern of LGE, to evaluate their prognostic performance in patients with HCM according to hypertension status.

TAKEAWAY

• Patients with HCM and concomitant hypertension had a greater extent of LGE (1.1 vs 0.9), more LGE multiple locations (17% vs 11%), and more midwall LGE (35% vs 28%) than those without hypertension (P ≤ .001 for all); however, no distinct differences in specific LGE locations were observed.
• Patients with hypertension experienced a higher annualised rate of mortality than those without hypertension (2.9% per year vs 1.7% per year; P = .007). After adjusting for baseline differences, hypertension was associated with a 32% higher risk for all-cause mortality (hazard ratio [HR], 1.32; P = .024).
• Hypertension in patients with HCM was also associated with a 21% increased risk for cardiac mortality (HR, 1.21; P = .034).
• The extent of LGE greater than three segments was associated with a higher risk for all-cause mortality in patients with and without hypertension (HR, 3.99 and 4.63, respectively), and the septal location of LGE also independently predicted mortality in both groups (HR, 1.76 and 1.48, respectively; P < .05 for all).

IN PRACTICE

"From a clinical perspective, [the study] findings support a cardiovascular risk stratification approach in HCM patients focused on: first, systematic identification of the higher cardiometabolic risk burden associated with concomitant hypertension; and second, refinement of risk stratification through integration of hypertension status and CMR [cardiovascular magnetic resonance]-LGE biomarkers during longitudinal follow-up," the researchers of the study wrote.

SOURCE

The study was led by Jeremy Florence, MD, Université Paris Cité, Department of Cardiology, University Hospital of Lariboisière, Paris, France. It was published online on July 13, 2026, in the European Journal of Preventive Cardiology.

LIMITATIONS

The study did not capture all factors potentially influencing the HCM phenotype, leaving the possibility of residual confounding. Only patients who underwent cardiac MRI were included, which may have limited the generalisability of the findings to the broader HCM population. Detailed longitudinal data on the duration of hypertension, blood pressure control, treatment intensity, and ambulatory blood pressure measurements were not available in the registry.

DISCLOSURES

One author received funding through "Année Recherche" of CHU de Clermont-Ferrand. The authors did not declare conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.