Intensive BP lowering reduces CV events in patients with hypertension, LV hypertrophy
In a cohort of patients with hypertension and left ventricular hypertrophy, those who achieved systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg demonstrated the lowest risk for CVD events, according to new results.
For the study, Hyeok-Hee Lee, MD, of Yonsei University College of Medicine in Seoul, and colleagues aimed to assess the link between on-treatment BP and CVD risk in adults with hypertension and LV hypertrophy. They culled data from the South Korean nationwide health examination database, identifying 95,545 participants (aged 40 to 79 years) with LV hypertrophy at baseline who were taking antihypertensive medication.
During follow-up (median, 11.5 years), researchers observed 12,035 new CVD events.
According to cubic spline models, the lowest risk for CVD events occurred with systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg. In multivariable-adjusted analysis, when the group with systolic BP 120 to 129 mm Hg was the reference, HRs were 1.31 (95% CI, 1.24-1.38) for the 140 mm Hg group; 1.08 (95% CI, 1.02-1.15) for the 130 to 139 mm Hg group; and 1.03 (95% CI, 0.93-1.15) for the < 120 mm Hg group.
In other multivariable-adjusted data, when the group with a diastolic BP of 70 to 79 mm Hg was the reference, HRs were 1.3 (95% CI, 1.24-1.37) for the 90 mm Hg group; 1.06 (95% CI, 1.01-1.12) for the 80 to 89 mm Hg group; and 1.08 (95% CI, 0.96-1.2) for the < 70 mm Hg group.
“Our findings indicate that the benefits of intensive BP lowering may outweigh, or at least balance with, the potential harms of myocardial hypoperfusion such that the lowest CVD risk can be achieved at BP < 130/80 mm Hg,” Lee and colleagues wrote. They added that the data also support intensive BP-lowering strategies for this patient population by reassuring log-linear associations of on-treatment systolic BP and diastolic BP with CVD risk without definite J-curve phenomena found in some observational studies.
“Further randomized trials are warranted to establish optimal BP-lowering strategies for patients with hypertension and [LV hypertrophy],” the researchers concluded.
In a related editorial, S. Andrew McCullough, MD, of Weill Cornell Medicine, and colleagues wrote that the findings provide further evidence that in patients with hypertension who are on therapy, many remain without optimal control — more than 75% of patients had either systolic BP > 130 mm Hg or diastolic BP > 80 mm Hg.
“Efforts should be made to address medication nonadherence and clinical inertia to treat to lower [systolic BP] goals, which are two principal drivers of poor control of hypertension,” McCullough and colleagues wrote. “Additional implementation science is needed to identify sustainable and scalable community-engaged approaches to improve hypertension control across diverse populations. Specifically, innovative and multifaceted approaches are needed to address the detection and treatment of hypertension in populations subject to income-, sex- and ethnicity-based health care inequities.”
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