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Effect of Lower Blood Pressure Goals on Left Ventricular Structure and Function in Patients With Subclinical
Phillip D Levy1,2, Michael J Burla3, Michael J Twiner1,2
1Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA.
Insights
Lowering blood pressure to below 130 mm Hg in patients with subclinical hypertensive heart disease (SHHD) may improve cardiac function. This intensive blood pressure management showed promise in a study of predominantly African American individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Subclinical hypertensive heart disease (SHHD) precedes heart failure.
- Blood pressure (BP) reduction is key for secondary prevention in SHHD patients.
- Intensive BP targets (<120/80 mm Hg) may improve cardiac function, but data, especially in African Americans (AAs), is limited.
Purpose of the Study:
- To evaluate the efficacy of intensive BP therapy versus standard therapy in patients with uncontrolled, asymptomatic hypertension and SHHD.
- To assess the impact of intensive BP management on cardiac function and reverse remodeling in a predominantly AA population.
Main Methods:
- A single-center, randomized controlled trial involving patients with uncontrolled, asymptomatic hypertension and SHHD.
- Participants were randomized to standard BP therapy (<140/90 mm Hg) or intensive BP therapy (<120/80 mm Hg).
- Outcomes included BP reduction and echocardiographic measures over 12 months with quarterly follow-ups.
Main Results:
- Despite significant BP reductions in both groups, no significant differences were observed in intention-to-treat analysis or SHHD resolution.
- Post hoc analysis revealed that achieving a systolic BP (sBP) <130 mm Hg was associated with significant reduction in indexed left ventricular mass.
- This reduction in left ventricular mass remained significant in mixed-effect modeling.
Conclusions:
- A systolic BP <130 mm Hg in predominantly AA patients with SHHD is linked to improved cardiac function and reverse remodeling.
- Lowering BP goals to <130 mm Hg may offer preventative benefits for cardiac structure and function in this population.
Background:
Subclinical hypertensive heart disease (SHHD) is a precursor to heart failure. Blood pressure (BP) reduction is an important component of secondary disease prevention in patients with SHHD. Treating patients with SHHD utilizing a more intensive BP target (120/80 mm Hg), may lead to improved cardiac function but there has been limited study of this, particularly in African Americans (AAs).
Methods:
We conducted a single center, randomized controlled trial where subjects with uncontrolled, asymptomatic hypertension, and SHHD not managed by a primary care physician were randomized to standard (<140/90 mm Hg) or intensive (<120/80 mm Hg) BP therapy groups with quarterly follow-up for 12 months. The primary outcome was the differences of BP reduction between these 2 groups and the secondary outcome was the improvement in echocardiographic measures at 12 months.
Results:
Patients (95% AAs, 65% male, mean age 49.4) were randomized to the standard (n = 65) or the intensive (n = 58) BP therapy groups. Despite significant reductions in systolic BP (sBP) from baseline (-10.9 vs. -19.1 mm Hg, respectively) (P < 0.05), no significant differences were noted between intention-to-treat groups (P = 0.33) or the proportion with resolution of SHHD (P = 0.31). However, on post hoc analysis, achievement of a sBP <130 mm Hg was associated with significant reduction in indexed left ventricular mass (-6.91 gm/m2.7; P = 0.008) which remained significant on mixed effect modeling (P = 0.031).
Conclusions:
In post hoc analysis, sBP <130 mm Hg in predominantly AA patients with SHHD was associated with improved cardiac function and reverse remodeling and may help to explain preventative effects of lower BP goals.
Clinical Trials Registration:
Trial Number NCT00689819.
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