Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Hypertension

The Systolic Blood Pressure Intervention (SPRINT) Trial

for the SPRINT Research Study Group

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND—: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of Left ventricular hypertrophy (LVH) in patients with hypertension, and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS—: This analysis included 8,164 participants (mean age 67.9 years, 35.3% women, 31.2% blacks) with hypertension but no diabetes from the Systolic Blood Pressure Intervention (SPRINT) Trial; 4,086 randomly assigned to intensive BP lowering (target systolic BP<120mmHg) and 4,078 assigned to standard BP lowering (target systolic BP <140mmHg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead electrocardiograms recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (vs. standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjusting for LVH as a time-varying covariate. RESULTS—: Among SPRINT participants without baseline LVH (n=7,559), intensive (vs. standard) BP lowering was associated with a 46% lower risk of developing LVH (HR=0.54, 95%CI: 0.43 to 0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (vs. standard) BP lowering were 66% more likely to regress/ improve their LVH (HR=1.66, 95%CI: 1.31 to 2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (HR (95%CI) of intensive vs. standard BP lowering on CVD: 0.76(0.64,0.90) and 0.77(0.65,0.91) before and after adjusting for LVH as a time-varying covariate, respectively). CONCLUSIONS—: Among patients with hypertension but no diabetes, intensive BP lowering (target systolic BP<120 mmHg), compared with standard BP lowering (target systolic BP<140 mmHg), resulted in lower rates of developing new LVH in those without LVH, and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION—: URL: ClinicalTrials.gov Unique Identifier: NCT01206062

Original languageEnglish (US)
JournalCirculation
DOIs
StateAccepted/In press - Jun 19 2017

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Left Ventricular Hypertrophy
Blood Pressure
Hypertension
Cardiovascular Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{1f6f38a9499240e7b972cbde65011202,
title = "Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Hypertension: The Systolic Blood Pressure Intervention (SPRINT) Trial",
abstract = "BACKGROUND—: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of Left ventricular hypertrophy (LVH) in patients with hypertension, and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS—: This analysis included 8,164 participants (mean age 67.9 years, 35.3{\%} women, 31.2{\%} blacks) with hypertension but no diabetes from the Systolic Blood Pressure Intervention (SPRINT) Trial; 4,086 randomly assigned to intensive BP lowering (target systolic BP<120mmHg) and 4,078 assigned to standard BP lowering (target systolic BP <140mmHg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead electrocardiograms recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (vs. standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjusting for LVH as a time-varying covariate. RESULTS—: Among SPRINT participants without baseline LVH (n=7,559), intensive (vs. standard) BP lowering was associated with a 46{\%} lower risk of developing LVH (HR=0.54, 95{\%}CI: 0.43 to 0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4{\%}), those assigned to the intensive (vs. standard) BP lowering were 66{\%} more likely to regress/ improve their LVH (HR=1.66, 95{\%}CI: 1.31 to 2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (HR (95{\%}CI) of intensive vs. standard BP lowering on CVD: 0.76(0.64,0.90) and 0.77(0.65,0.91) before and after adjusting for LVH as a time-varying covariate, respectively). CONCLUSIONS—: Among patients with hypertension but no diabetes, intensive BP lowering (target systolic BP<120 mmHg), compared with standard BP lowering (target systolic BP<140 mmHg), resulted in lower rates of developing new LVH in those without LVH, and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION—: URL: ClinicalTrials.gov Unique Identifier: NCT01206062",
author = "{for the SPRINT Research Study Group} and Soliman, {Elsayed Z.} and Ambrosius, {Walter T.} and Cushman, {William C.} and Zhang, {Zhu Ming} and Bates, {Jeffrey T.} and Neyra, {Javier A.} and Carson, {Thaddeus Y.} and Leonardo Tamariz and Lama Ghazi and Cho, {Monique E.} and Shapiro, {Brian P.} and Jiang He and Fine, {Lawrence J.} and Lewis, {Cora E.}",
year = "2017",
month = "6",
day = "19",
doi = "10.1161/CIRCULATIONAHA.117.028441",
language = "English (US)",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Hypertension

T2 - The Systolic Blood Pressure Intervention (SPRINT) Trial

AU - for the SPRINT Research Study Group

AU - Soliman, Elsayed Z.

AU - Ambrosius, Walter T.

AU - Cushman, William C.

AU - Zhang, Zhu Ming

AU - Bates, Jeffrey T.

AU - Neyra, Javier A.

AU - Carson, Thaddeus Y.

AU - Tamariz, Leonardo

AU - Ghazi, Lama

AU - Cho, Monique E.

AU - Shapiro, Brian P.

AU - He, Jiang

AU - Fine, Lawrence J.

AU - Lewis, Cora E.

PY - 2017/6/19

Y1 - 2017/6/19

N2 - BACKGROUND—: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of Left ventricular hypertrophy (LVH) in patients with hypertension, and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS—: This analysis included 8,164 participants (mean age 67.9 years, 35.3% women, 31.2% blacks) with hypertension but no diabetes from the Systolic Blood Pressure Intervention (SPRINT) Trial; 4,086 randomly assigned to intensive BP lowering (target systolic BP<120mmHg) and 4,078 assigned to standard BP lowering (target systolic BP <140mmHg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead electrocardiograms recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (vs. standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjusting for LVH as a time-varying covariate. RESULTS—: Among SPRINT participants without baseline LVH (n=7,559), intensive (vs. standard) BP lowering was associated with a 46% lower risk of developing LVH (HR=0.54, 95%CI: 0.43 to 0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (vs. standard) BP lowering were 66% more likely to regress/ improve their LVH (HR=1.66, 95%CI: 1.31 to 2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (HR (95%CI) of intensive vs. standard BP lowering on CVD: 0.76(0.64,0.90) and 0.77(0.65,0.91) before and after adjusting for LVH as a time-varying covariate, respectively). CONCLUSIONS—: Among patients with hypertension but no diabetes, intensive BP lowering (target systolic BP<120 mmHg), compared with standard BP lowering (target systolic BP<140 mmHg), resulted in lower rates of developing new LVH in those without LVH, and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION—: URL: ClinicalTrials.gov Unique Identifier: NCT01206062

AB - BACKGROUND—: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of Left ventricular hypertrophy (LVH) in patients with hypertension, and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS—: This analysis included 8,164 participants (mean age 67.9 years, 35.3% women, 31.2% blacks) with hypertension but no diabetes from the Systolic Blood Pressure Intervention (SPRINT) Trial; 4,086 randomly assigned to intensive BP lowering (target systolic BP<120mmHg) and 4,078 assigned to standard BP lowering (target systolic BP <140mmHg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead electrocardiograms recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (vs. standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjusting for LVH as a time-varying covariate. RESULTS—: Among SPRINT participants without baseline LVH (n=7,559), intensive (vs. standard) BP lowering was associated with a 46% lower risk of developing LVH (HR=0.54, 95%CI: 0.43 to 0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (vs. standard) BP lowering were 66% more likely to regress/ improve their LVH (HR=1.66, 95%CI: 1.31 to 2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (HR (95%CI) of intensive vs. standard BP lowering on CVD: 0.76(0.64,0.90) and 0.77(0.65,0.91) before and after adjusting for LVH as a time-varying covariate, respectively). CONCLUSIONS—: Among patients with hypertension but no diabetes, intensive BP lowering (target systolic BP<120 mmHg), compared with standard BP lowering (target systolic BP<140 mmHg), resulted in lower rates of developing new LVH in those without LVH, and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION—: URL: ClinicalTrials.gov Unique Identifier: NCT01206062

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U2 - 10.1161/CIRCULATIONAHA.117.028441

DO - 10.1161/CIRCULATIONAHA.117.028441

M3 - Article

JO - Circulation

JF - Circulation

SN - 0009-7322

ER -