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Middle-Aged and Older Patients With Left Ventricular Hypertrophy: Higher Mortality With Drug Treated Systolic Blood

Sondre Heimark1,2,3, Maria H Mehlum4, Giuseppe Mancia5

  • 1Institute of Clinical Medicine (S.H., S.E.K., A.C.L.), University of Oslo, Norway.

Hypertension (Dallas, Tex. : 1979)
|June 23, 2023
PubMed

Insights

Lowering systolic blood pressure (SBP) below 130 mm Hg may harm patients with left ventricular hypertrophy (LVH). This study found increased cardiac and all-cause mortality in LVH patients achieving SBP <130 mm Hg.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Trials

Background:

  • Left ventricular hypertrophy (LVH) affects approximately 40% of hypertension patients.
  • LVH patients may have compromised myocardial microcirculation, increasing sensitivity to aggressive blood pressure reduction.
  • The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial investigated treatment strategies for hypertension.

Purpose of the Study:

  • To determine if achieving an average systolic blood pressure (SBP) below 130 mm Hg poses a risk in patients with LVH.
  • To evaluate the safety and efficacy of intensive SBP lowering in hypertensive individuals with LVH.

Main Methods:

  • Analysis of 13,803 participants from the VALUE trial, excluding those with early cardiovascular events.
  • Comparison of cardiac and all-cause mortality in patients with and without electrocardiographic LVH (ECG-LVH).
  • Stratification based on achieved average SBP levels (<130 mm Hg vs. 130-139 mm Hg vs. ≥140 mm Hg) using Cox regression analysis.

Main Results:

  • Patients without LVH achieving SBP <130 mm Hg showed reduced cardiovascular endpoints.
  • Patients with ECG-LVH achieving SBP <130 mm Hg experienced significantly higher cardiac mortality (HR 1.98) and all-cause mortality (HR 1.74).
  • SBP <130 mm Hg was not associated with any reduction in endpoints for the ECG-LVH group.

Conclusions:

  • Aggressive SBP reduction to <130 mm Hg may be harmful for patients with ECG-LVH.
  • Caution is advised when targeting SBP <130 mm Hg in middle-aged and older adults with LVH.
  • Further research is needed to establish optimal SBP targets for hypertensive patients with LVH.
Abstract

Keywords:
all-cause mortalityantihypertensive treatmentblood pressure targetcardiac mortalityhypertensionleft ventricular hypertrophy

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