Blood Pressure Remained Stable After Mavacamten in oHCM

Patients with obstructive hypertrophic cardiomyopathy (oHCM) treated with the cardiac myosin inhibitor (CMI) mavacamten had stable blood pressure over approximately 3 months while left ventricular outflow tract (LVOT) gradients declined substantially, according to a retrospective single-center study published in the Journal of the American College of Cardiology.

“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,” wrote the researchers of the study. “Cardiac myosin inhibitors (CMIs), such as mavacamten, reduce hypercontractility and LVOT gradients, but management of concomitant BP-directed therapies in routine practice remains uncertain.”

Why Blood Pressure Management in oHCM Is Complicated

Vasodilating antihypertensive medications can worsen dynamic LVOT obstruction, which has historically led clinicians to approach blood pressure management conservatively in patients with oHCM.² Mavacamten (Camzyos; Bristol Myers Squibb) works differently by directly reducing sarcomere hypercontractility rather than acting on afterload, raising questions about how antihypertensive therapy should be managed after CMI initiation.

Researchers at Atrium Health Wake Forest Baptist retrospectively reviewed 34 adults with oHCM treated with mavacamten from a broader registry of 139 patients with hypertrophic cardiomyopathy. Nearly two-thirds (67.6%) of patients had pre-existing hypertension.

At approximately 3 months, patients with hypertension were taking renin-angiotensin system inhibitors (n = 11), mineralocorticoid receptor antagonists (n = 11), or diuretics (n = 4). No patient without baseline hypertension was receiving antihypertensive therapy, and none developed new-onset hypertension during follow-up.

LVOT gradients declined significantly in both groups, from 77.1 to 27.0 mmHg among patients with hypertension and from 66.3 to 19.3 mmHg among those without hypertension (both P < .05), while systolic and diastolic blood pressure remained statistically unchanged in each group.

β-blockers and calcium channel blockers were tracked separately from antihypertensive agents, as they are commonly used in oHCM for obstruction, symptom control, or rhythm management rather than hypertension specifically.

However, the authors note that this single-center retrospective analysis lacked a control group, included a modest sample size with short follow-up, and reflected routine clinical medication adjustments rather than a controlled treatment protocol. They call for prospective, multicenter studies to better define optimal antihypertensive strategies in patients with oHCM receiving CMI therapy. The authors also note that comorbidities such as obesity and obstructive sleep apnea warrant attention as part of comprehensive oHCM management.

“Following mavacamten initiation, LVOT gradients improved and BP [blood pressure] remained stable in patients with and without HTN,” wrote the researchers. “These findings suggest that individualized BP management is feasible during CMI therapy and support prospective evaluation.”

Managed Care Implications

For payers, these findings arrive alongside continued scrutiny of mavacamten’s value and access barriers. A one-year postapproval review of payer policies found wide variation in coverage requirements, with most plans mandating documentation of an inadequate response to β-blockers or calcium channel blockers before authorizing mavacamten, and some requiring genetic testing, which researchers identified as a potentially unnecessary barrier.³

These findings add to emerging real-world evidence suggesting that antihypertensive therapy may often be continued during mavacamten treatment with appropriate clinical monitoring, although prospective studies are needed to define optimal management strategies. As additional cardiac myosin inhibitors move through development and REMS-related monitoring requirements remain a factor in total cost-of-care discussions, these data may help inform future coverage policies and monitoring approaches.

References

1. Paik KS, Wright Z, Gokul K, et al. Hypertension management in obstructive hypertrophic cardiomyopathy patients treated with cardiac myosin inhibitors - real world data. JACC.
   https://doi.org/10.1016/j.jacc.2026.02.1876
2. Ommen S, Ho CY, Asif IM et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(23):e1239-e1311. doi: 10.1161/CIR.0000000000001250
3. Beinfield MT, Enright D, Wasfy JH. Variation in payer coverage of mavacamten (Camzyos) for hypertrophic cardiomyopathy: one year post approval. Center for the Evaluation of Value and Risk in Health, Tufts Medical Center. August 9, 2023. Accessed July 7, 2026. https://cevr.tuftsmedicalcenter.org/news/variation-in-payer-coverage-of-mavacamten-camzyos-for-hypertrophic-cardiomyopathy-one-year-post-approval