Hypertension management in obstructive hypertrophic cardiomyopathy patients treated with cardiac myosin inhibitors - real world data.

BACKGROUND

Management of hypertension (HTN) in obstructive hypertrophic cardiomyopathy (oHCM) is challenging because blood pressure (BP)-directed therapies may exacerbate left ventricular outflow tract (LVOT) obstruction. Cardiac myosin inhibitors (CMIs), such as mavacamten, reduce hypercontractility and LVOT gradients, but management of concomitant BP-directed therapies in routine practice remains uncertain.

METHODS

We conducted a retrospective single-center cohort study of adults with oHCM treated with mavacamten. Patients were stratified by pre-existing HTN status, with clinical, medication, BP, and echocardiographic data collected at baseline and approximately three months. BP-directed therapies included renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and diuretics. Beta-blockers and calcium channel blockers were described separately because of their common use for LVOT obstruction, symptom control, or arrhythmia/rate control.

RESULTS

Among 34 patients, 23 (67.6%) had pre-existing HTN. At three months, BP-directed therapies among patients with HTN included renin-angiotensin system inhibitors in 11, mineralocorticoid receptor antagonists in 11, and diuretics in 4; no patient without baseline HTN received BP-directed therapy. LVOT gradients decreased significantly in the HTN and non-HTN groups, from 77.1 to 27.0 mmHg and from 66.3 to 19.3 mmHg, respectively (both p < 0.05). Systolic and diastolic BP remained stable in both groups, and no patient developed incident HTN.

CONCLUSION

Following mavacamten initiation, LVOT gradients improved and BP remained stable in patients with and without HTN. These findings suggest that individualized BP management is feasible during CMI therapy and support prospective evaluation.