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Intensive BP lowering may reduce risk for LV hypertrophy
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Intensive BP-lowering therapy for patients with hypertension who do not have diabetes reduced the risk for left ventricular hypertrophy or regressed the condition, according to a study in Circulation.
“We know that high [BP] could lead to [LV hypertrophy], and we know that lowering this pressure to the recommended levels improves it, but we didn’t know if intensive lowering of [BP] beyond recommended would lead to more improvement in heart muscle,” Elsayed Z. Soliman, MD, director of the epidemiological cardiology research center at Wake Forest School of Medicine in Winston-Salem, North Carolina, said in a press release.
Researchers analyzed data from 8,164 patients (mean age, 68 years; 35% women) from the SPRINT trial who were assigned intensive BP lowering with a systolic BP goal of less than 120 mm Hg (n = 4,086) or standard BP lowering with a systolic BP goal of less than 140 mm Hg (n = 4,078). Patients were followed up every 3 months for a median follow-up of 3.81 years to collect laboratory and clinical data, including BP measurements and self-reported CVD outcomes.
Of patients who did not have LV hypertrophy at baseline (n = 7,559), 324 patients developed the condition, with most of those in the standard BP group (n = 206). The risk for LV hypertrophy decreased in patients assigned intensive BP lowering by 46% (HR = 0.54; 95% CI, 0.43-0.68) compared with those assigned standard BP goals.
The prevalence of regression of or improvement in LV hypertrophy was 66% more likely in patients assigned intensive BP lowering (HR = 1.66; 95% CI, 1.31-2.11) than standard BP lowering.
Intensive BP lowering greatly affected the rate of CVD outcomes compared with standard BP lowering (HR = 0.76; 95% CI, 0.64-0.9). The effect remained after researchers adjusted for LV hypertrophy as a time-varying covariate (HR = 0.77; 95% CI, 0.65-0.91).
“These findings add further evidence of the benefits of the intensive BP lowering in patients with hypertension, and suggest that these benefits go beyond reducing the hemodynamic stress on the cardiac structure,” Soliman and colleagues wrote. “Understanding the mediating factors and the mechanisms by which intensive BP lowering impacts the [CV] system would help in better selection of those who may benefit with least harm.” – by Darlene Dobkowski
Disclosures: The researchers report no relevant financial disclosures.
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George L. Bakris, MD
Soliman and colleagues evaluated data from the SPRINT on the extent to which LV hypertrophy development or regression may account for additional CV risk reduction seen in the trial. They included 8,164 participants in the analysis who were mostly men, had a mean age 67.9 years, and about 1/3 were black participants. They defined progression and regression of LV hypertrophy by Cornell voltage criteria derived from standard 12-lead ECGs recorded at baseline and biannually. These were compared between treatment arms over 3.81 years. They noted that intensive BP lowering was associated with a 46% lower risk for developing LV hypertrophy. Moreover, among those with baseline LV hypertrophy (about 7.4%), the intensive BP lowering group were 66% more likely to regress or improve their LV hypertrophy.
The authors concluded that among patients with hypertension and no diabetes, intensive BP lowering resulted in lower rates of developing new LV hypertrophy in those without LV hypertrophy, and higher rates of LV hypertrophy regression among those with existing LV hypertrophy. However, this effect did not explain the outcomes.
The data from this post hoc analysis are not surprising at all. LV hypertrophy is a pathophysiologic adaption to sustained high arterial pressures. So, no one should be surprised that lowering pressure into the normal range over time is associated with regression or prevention of LV hypertrophy.
This study confirms what we knew. Moreover, while LV hypertrophy is associated with higher CV risk, its regression is not always associated with a good outcome, hence, like microalbuminuria, it is a marker of disease magnitude, not a risk factor.
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