Effect of intensive blood pressure control on cardiovascular remodeling in hypertensive patients with nephrosclerosis

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• Pulse pressure (PP) is a key indicator of arterial stiffness and is associated with cardiovascular (CV) complications.
• Left-ventricular hypertrophy (LVH) is a significant predictor of CV events.

Purpose of the Study:

• To investigate the association between pulse pressure and composite CV outcomes and new-onset LVH.
• To evaluate the effect of mean arterial pressure (MAP) control on the rate of PP change.

Main Methods:

• The study analyzed 1094 nondiabetic participants with nephrosclerosis from the African American Study of Kidney Disease and Hypertension.
• Participants were randomized to a usual MAP goal (102-107 mmHg) or a lower MAP goal (≤92 mmHg) and assigned to different antihypertensive medications.
• Covariate adjustments were performed to analyze the relationships between PP, CV outcomes, LVH, and MAP control.

Main Results:

• A higher pulse pressure was significantly associated with an increased risk of composite CV outcomes (RR = 1.28) and new LVH (RR = 1.26).
• Pulse pressure increased at a significantly greater rate in the usual MAP goal group compared to the lower MAP goal group (1.08 vs. 0.42 mmHg/year).
• Antihypertensive treatment assignment did not significantly affect the rate of PP change.

Conclusions:

• Controlling mean arterial pressure to a lower target (≤92 mmHg) effectively slows the progression of pulse pressure.
• Slowing pulse pressure progression may be a beneficial strategy for improving cardiovascular health and reducing remodeling and complications.
• These findings highlight the importance of MAP control in managing arterial properties and mitigating cardiovascular risk.