The impact of anemia on left ventricular function and deformation in patients with essential hypertension: a cardiac magnetic resonance study

Background: Hypertension (HTN) and anemia contribute to left ventricular (LV) hypertrophy and are associated with adverse outcomes. Anemia is often overlooked in patients with HTN, and its combined impact on the heart may be underestimated. The study aims to investigate the additive effects of anemia on LV function and global strains in individuals with essential HTN, utilizing cardiac magnetic resonance (CMR) imaging. Methods: A total of 238 patients diagnosed with HTN and 67 sex- and age-matched controls who underwent CMR examination were retrospectively included. All HTN patients were divided into two groups: 88 with anemia and 150 without anemia. LV performance was evaluated using CMR including LV function parameters, LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS). Comparisons among the three groups were conducted using one-way analysis of variance (ANOVA), the Kruskal-Wallis test, or the Chi-squared test. Additionally, multivariable linear regression analysis was performed to investigate factors associated with LV global strains. Results: The HTN patients with anemia were older and had lower hemoglobin concentration and estimated glomerular filtration rate, and higher indices for LV end-diastolic volume, end-systolic volume, mass index, and mass/volume ratio compared with the control group and HTN without anemia group (all P<0.001). Additionally, the GLPS and GCPS deteriorated progressively from the HTN without anemia group to the HTN with anemia group when compared with the control group (all P<0.001). After adjusting for age, GLPS (−10.40%±0.46% vs. −11.95%±0.35%, P=0.008), GCPS (−16.60%±0.52% vs. −18.08%±0.39%, P=0.025), and GRPS (28.95%±1.49% vs. 32.72%±1.14%, P=0.048) were significantly poorer in HTN patients with anemia compared with those without anemia. Furthermore, multivariate analysis revealed significant independent associations between anemia and GLPS (β =0.308, P=0.002), GCPS (β =0.273, P=0.004), and GRPS (β =−0.142, P=0.021). Conclusions: Anemia has additive deleterious effects on LV function and global strains in patients with HTN. Regular monitoring and early intervention of anemia might be beneficial for patients with HTN.