Jedrzejewski, Dawid; (2025) Blood pressure, the left ventricle and impact of treatment in hypertension. Doctoral thesis (Ph.D), UCL (University College London).

Text PhD Thesis Final.pdf - Accepted Version Access restricted to UCL open access staff until 1 October 2026. Download (11MB)

Abstract

Background: Cardiovascular disease, which is a leading cause of death, is often caused or accelerated by hypertension. Better risk stratification, especially for younger patients, to identify those at greater cardiovascular risk could reduce deaths. There has been less focus on risk stratification in younger patients and especially in those with milder elevations in blood pressure, making it controversial whether such patients should be treated. / Objectives: Compare central aortic systolic pressure (CASP) against brachial systolic blood pressure (SBP) for risk stratification. Evaluate early impact of hypertension on cardiac function and arterial stiffness, and potential need for earlier intervention and lower blood pressure targets for treatment. / Methods: Meta-analysis (Chapter 1) of CASP and SBP derived from different pulse wave calibration methods. Observational study (Chapter 2) comparing left ventricular function and arterial stiffness in younger men with mild hypertension. Randomised controlled trial (Chapter 3) evaluating effects of 1-year of antihypertensive treatment on left ventricular function and arterial stiffness. Observational study (Chapter 4) assessing reference LVMI in optimal blood pressure to evaluate effectiveness of antihypertensive treatment. / Results: Elevated blood pressure was associated with worse indices of left ventricular function and arterial stiffening. Guideline-based antihypertensive therapy improved arterial stiffness and left ventricular function, but did not reduce LVMI to the level seen in those with optimal blood pressure. / Conclusions: This thesis shows inconsistencies in published data regarding CASP derivation. In mild hypertension, this thesis shows left ventricular function and arterial stiffness deterioration. Their improvements with antihypertensive treatment suggest need for an earlier intervention.

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