Cited by 0Cardiomyopathy and Myosin StudiesBlood Pressure and Hypertension StudiesCardiovascular Function and Risk Factors

The DOI matches its Crossref record; 7 of the 7 references it cites were found in a registry or an index; none of the 9 sources its claims cite is checked for support yet.

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

Open access
Paik, Kenneth S., Wright, Zachary, Gokul, Kaushik, Seals, Austin, Raman, Deevya, Sundaravel, Swethika·2026·International Journal of Cardiology

Abstract

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.

Overview

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Written from the paper’s full text.

TL;DR

In a single-center retrospective cohort of 34 adults with obstructive hypertrophic cardiomyopathy treated with mavacamten, LVOT gradients decreased significantly at approximately three months in both baseline hypertension and non-hypertension groups while blood pressure remained stable. BP-directed therapies were used only in patients with pre-existing hypertension, and no patient without baseline hypertension developed incident hypertension.

Key findings

  • Among 34 patients, 23 (67.6%) had pre-existing hypertension. At approximately three months, BP-directed therapies among patients with hypertension included RAS inhibitors (n = 11), MRAs (n = 11), and diuretics (n = 4); no patient without baseline hypertension received BP-directed therapy.
  • LVOT gradients decreased significantly in both groups: from 77.1 to 27.0 mmHg in the hypertension group and from 66.3 to 19.3 mmHg in the non-hypertension group (both p < 0.05; Table 2 p < 0.0001 and p = 0.0038, respectively).
  • Blood pressure remained stable. In the non-hypertension group, systolic BP changed from 121.0 ± 14.7 to 126.0 ± 10.4 mmHg (p = 0.438) and diastolic BP from 67.3 ± 6.2 to 69.0 ± 9.5 mmHg (p = 0.719). In the hypertension group, systolic BP changed from 128.7 ± 10.6 to 128.8 ± 17.8 mmHg (p = 0.794) and diastolic BP from 70.7 ± 8.6 to 72.0 ± 14.5 mmHg (p = 0.224). No patient developed incident hypertension.
  • Beta-blockers were used in 11/23 patients (47.8%) with hypertension and 3/11 patients (27.3%) without hypertension; calcium channel blockers were used in 4/23 patients (17.4%) with hypertension and 3/11 patients (27.3%) without hypertension.

Methods

  • Retrospective single-center cohort study of adults with obstructive hypertrophic cardiomyopathy treated with mavacamten at a tertiary academic center, identified from an institutional registry and included if they had symptomatic oHCM and available baseline and approximately three-month follow-up data. Among 139 patients with hypertrophic cardiomyopathy, 74 had obstructive physiology, and 34 treated with mavacamten comprised the analytic cohort.
  • Patients were stratified by documented pre-existing hypertension before mavacamten initiation. Data extracted from the electronic medical record included demographics, comorbidities, BP measurements, medication use, and echocardiographic parameters. BP-directed therapies were limited to RAS inhibitors, MRAs, and diuretics; beta-blockers and calcium channel blockers were described separately.
  • The primary outcome was change in systolic and diastolic BP at approximately three months; secondary outcomes included changes in LVOT gradient and patterns of concomitant medication use. Continuous variables are presented as mean ± standard deviation; within-group changes used paired Wilcoxon signed-rank testing, between-group comparisons used Kruskal-Wallis testing, and a two-sided p-value <0.05 was considered statistically significant. Analyses were performed using R version 4.4.1.

Limitations

  • The paper states that this is a single-center retrospective analysis with a modest sample size and short follow-up duration; medication adjustments were not protocolized and reflect real-world practice, which may introduce confounding; the sample size did not support robust comparisons according to individual BP-directed drug class or combinations; and longer-term BP outcomes and clinical endpoints were not assessed.
  • Evident from the text: the observational design without a control or comparator group cannot establish causality, and findings from one tertiary academic center may not generalize to other settings.

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Integrity signals

Registry

Crossref · 10.1016/j.ijcard.2026.134661

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Image 1
CC-BY · From the PDF

Verification

Claims the paper makes

14 Own result · 8 Sources not found · 5 Own method · 5 Own interpretation · 2 No basis given

Show all 18 claims

  • It may state two separate claims as one. 14
  • Probably not a substantial claim. 8
16 of 16
  • The paper relies on this without support.

    Optimal management of concomitant blood pressure-directed therapy in oHCM patients treated with cardiac myosin inhibitors remains uncertain.

    “Real-world evidence is increasingly supporting these benefits; however, optimal management of concomitant BP-directed therapy remains uncertain.”
  • The paper relies on this without support.

    There is limited real-world evidence evaluating whether continuation of therapies primarily intended for blood pressure control affects the early hemodynamic response to cardiac myosin inhibitors.

    “Still, there is limited real-world evidence evaluating whether continuation of therapies primarily intended for BP control affects the early hemodynamic response to CMIs.”
2 of 2

Citations

Cites

Show all 6 references

Research works printed but not linked: 2

  1. Heitner, 2022, Mavacamten treatment for obstructive hypertrophic cardiomyopathy: a phase 2 study (REDWOOD-HCM), Circ. Heart Fail., 15
  2. Saberi, 2023, Long-term treatment with mavacamten in patients with obstructive hypertrophic cardiomyopathy, J. Am. Coll. Cardiol., 82, 2310

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Metadata

Authors
Paik, K. S., Wright, Z., Gokul, K., Seals, A., Raman, D., & Sundaravel, S.
Affiliations
  • Atrium Health Wake Forest Baptist (US)
  • Wake Forest University Health Sciences (US)
Corresponding author
Paik, Kenneth S.
Venue
International Journal of Cardiology
Publisher
Elsevier BV
Published
2026-10
Volume
461
Pages
134661
ISSN
0167-5273 (ISSN-L)
OpenAlex
W7167408678
Cited by
0
References
6
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • International Journal of Cardiology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
hypertrophic obstructive cardiomyopathy, hypertension, cardiac myosin inhibitor, mavacamten, left ventricular outflow tract obstruction, blood pressure control, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, diuretics, beta-blockers, calcium channel blockers, left ventricular outflow tract gradient
MeSH terms
Ventricular Outflow Obstruction, Left, Aged, Antihypertensive Agents, Benzylamines, Cardiomyopathy, Hypertrophic, Female, Humans, Hypertension, Male, Middle Aged, Retrospective Studies, Uracil, Cohort Studies, Treatment Outcome, Disease Management, Cardiac Myosins

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