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Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy

Simon B Ascher1, James A de Lemos2, MinJae Lee3

  • 1Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California-San Francisco, San Francisco, California, USA; Division of Hospital Medicine, University of California-Davis, Sacramento, California, USA.

Journal of the American College of Cardiology
|October 13, 2022
PubMed

Insights

Intensive systolic blood pressure control effectively prevented malignant left ventricular hypertrophy (LVH) and reduced the risk of heart failure and death in high-risk patients.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Heart Failure Prevention

Background:

  • Malignant left ventricular hypertrophy (LVH), characterized by cardiac biomarkers of injury and neurohormonal stress, signifies a high risk for heart failure and mortality.
  • Identifying effective interventions for malignant LVH is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the impact of intensive systolic blood pressure (SBP) control on preventing malignant LVH and its associated adverse events.
  • To assess the effects of intensive SBP lowering compared to standard control on heart failure events and mortality.

Main Methods:

  • The SPRINT (Systolic Blood Pressure Intervention Trial) enrolled 8,820 participants categorized by baseline LVH (assessed by ECG) and cardiac biomarker levels.
  • Participants were randomized to intensive vs. standard SBP lowering targets.
  • Outcomes included rates of acute decompensated heart failure (ADHF), death, and the incidence/regression of malignant LVH.

Main Results:

  • Intensive SBP lowering significantly reduced the incidence of malignant LVH (2.5% vs. 1.1%).
  • The absolute risk reduction in the composite of ADHF events and death over 4 years was 4.4% for participants with baseline malignant LVH.
  • Relative risk reductions for ADHF events and death were similar across groups, but absolute benefits were greater in those with malignant LVH.

Conclusions:

  • Intensive SBP lowering is effective in preventing the development of malignant LVH.
  • This intensive approach offers a substantial absolute risk reduction for the composite outcome of ADHF events and death in patients with pre-existing malignant LVH.
Abstract

Keywords:
heart failurehypertensionmalignant LVHnatriuretic peptidetroponin

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