Can myocardial work help in the therapy of resistant hypertension?

[...]to Doppler-derived parameters (pulsed or tissue Doppler), GLS provides angle independent and significantly less load-dependent measurement. 2 However, GLS is not completely load independent parameter and study involved hemodialysis patients showed that GLS was different in the same patients before and after dialysis. 3 Despite this limitation GLS was proven to be an important predictor of cardiovascular (CV) events in hemodialysis patients. 4 The importance of GLS in arterial hypertension is well established and it has been even involved in the guidelines for imaging in hypertensive patients. 5 It was also demonstrated that GLS has a significant predictive value, that was higher of LVEF for prediction of CV events. 6 Hypertensive heart disease, that is frequently developed in patients with resistant hypertension, is characterized by interstitial fibrosis that can be effectively detected by cardiac magnetic resonance and increased extracellular volume, but represents a major challenge for echocardiographic assessment. 7 Strain evaluation provides the best echocardiographic surrogate for evaluation of interstitial fibrosis not only in hypertension, but also in other diseases that result with interstitial fibrosis. [...]MW delivers four indexes: global constructive work index, myocardial work index, global myocardial work efficiency, and global wasted work. [...]the effect of different risk factors, including hypertension, on MW is not completely resolved because some studies showed positive relationship between systolic BP and global work index and global constructive work 11,12 in general and hypertensive population, whereas other studies showed no difference in MW parameters between hypertensive patients at different stage of hypertension. 13 Recent study demonstrated the significant predictive value of lower cardiac work index on all-cause mortality in patients receiving regular hemodialysis. 14 This would imply that hypertensive patients, who typically have higher cardiac work index, are under lower risk for adverse outcomes. [...]it remains unclear if this effect on BP represents maximally achieved BP reduction or perhaps a new plateau followed by an even greater decline in BP.