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Intensive Blood Pressure Lowering Improves Left Ventricular Hypertrophy in Older Patients with Hypertension: The STEP

Yue Deng1, Wei Liu2, Xinchun Yang3

  • 1Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing (Y.D., J.C.).

Hypertension (Dallas, Tex. : 1979)
|June 1, 2023
PubMed

Insights

Intensive systolic blood pressure lowering significantly reduced the risk of new left ventricular hypertrophy (LVH) in older hypertensive patients. However, this protective effect did not fully account for the observed reduction in cardiovascular events.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Trials

Background:

  • Intensive systolic blood pressure (SBP) lowering is increasingly utilized, but its impact on cardiac remodeling, specifically left ventricular hypertrophy (LVH), requires further elucidation.
  • This study analyzes data from the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients trial to assess LVH changes under intensive SBP management.

Purpose of the Study:

  • To determine the effect of intensive SBP lowering on the development and progression of left ventricular hypertrophy (LVH) in elderly hypertensive patients.
  • To evaluate whether the reduction in cardiovascular events associated with intensive SBP lowering is mediated by changes in LVH.

Main Methods:

  • A secondary analysis of 7141 hypertensive patients randomized to intensive (SBP target, 110-130 mm Hg) or standard (130-150 mm Hg) treatment.
  • Left ventricular hypertrophy (LVH) was assessed using the Peguero-Lo Presti criteria on 12-lead echocardiograms, with follow-up for a median of 3.24 years.

Main Results:

  • Intensive SBP lowering significantly reduced the risk of new LVH occurrence (HR, 0.76; P=0.001) and slowed the progression of LVH (mean Peguero-Lo Presti value change, -23.47 μV/y).
  • Rates of LVH regression did not differ significantly between groups.
  • The cardiovascular benefits of intensive SBP lowering (HR, 0.75) were not substantially altered when accounting for LVH as a covariate.

Conclusions:

  • Intensive SBP lowering demonstrates a protective effect against the development of LVH in older adults with hypertension.
  • While intensive SBP lowering benefits cardiac remodeling, it does not fully explain the significant reduction in cardiovascular events observed in these patients.
Abstract

Keywords:
blood pressurecardiovascular diseaseelderlyhypertrophy

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