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Effects of intensive blood pressure control on left ventricular hypertrophy in aortic valve disease
Mijin Kim1, Jung-Hyun Choi2, Hyung-Kwan Kim3
1Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
Insights
Intensive blood pressure control significantly reduced left ventricular (LV) hypertrophy in patients with aortic valve disease. This finding suggests a benefit of tighter BP management for these individuals.
Area of Science:
- Cardiology
- Hypertension Management
- Valvular Heart Disease
Background:
- Hypertension exacerbates left ventricular (LV) pressure overload in patients with aortic valve (AV) disease.
- Optimal blood pressure (BP) targets for AV disease patients are not well-defined.
- Investigating intensive BP control's effect on LV hypertrophy in AS or AR patients.
Purpose of the Study:
- To determine if intensive BP control reduces LV hypertrophy in asymptomatic patients with aortic stenosis (AS) or aortic regurgitation (AR).
Main Methods:
- 128 hypertensive patients with mild to moderate AS or AR were randomized to intensive BP therapy (<130 mm Hg systolic) or standard therapy (<140 mm Hg systolic).
- Primary endpoint: change in LV mass at 24 months.
- Secondary endpoints: changes in AV disease severity, LV volumes, ejection fraction, and global longitudinal strain (GLS).
Main Results:
- Intensive therapy group achieved mean systolic BP of 129 mm Hg vs. 135 mm Hg in standard therapy group at 24 months.
- LV mass significantly decreased in the intensive therapy group (-3.9 g) compared to an increase in the standard therapy group (10.3 g) (P=.0007).
- No significant differences in secondary endpoints or AV disease progression were observed between groups.
Conclusions:
- Intensive hypertensive therapy significantly reduced LV hypertrophy in patients with AV disease.
- The progression of AV disease was similar between intensive and standard BP control groups.
- Tighter BP control may be beneficial for managing LV hypertrophy in hypertensive patients with AV disease.
Background:
Hypertension adds to the pressure overload on the left ventricle (LV) in combination with aortic valve (AV) disease, but the optimal blood pressure (BP) targets for patients with AV disease remain unclear. We tried to investigate whether intensive BP control reduces LV hypertrophy in asymptomatic patients with aortic stenosis (AS) or aortic regurgitation (AR).
Methods:
A total of 128 hypertensive patients with mild to moderate AS (n = 93) or AR (n = 35) were randomly assigned to intensive therapy, targeting a systolic BP <130 mm Hg, or standard therapy, targeting a systolic BP <140 mm Hg. The primary end point was the change in LV mass from baseline to the 24-month follow-up. Secondary end points included changes in severity of AV disease, LV volumes, ejection fraction and global longitudinal strain (GLS).
Results:
The treatment groups were generally well balanced regarding the baseline characteristics. The mean (±SD) age of the patients was 68 ± 8 years and 48% were men. The mean BP was 145 ± 12/81 ± 10 mm Hg at baseline. Medication at baseline was similar between the 2 groups. The 2 treatment strategies resulted in a rapid and sustained difference in systolic BP (P < .05). At 24-month, the mean systolic BP was 129 ± 12 mm Hg in the intensive therapy group and 135 ± 14 mm Hg in the standard therapy group. No patient died or underwent AV surgery during follow-up in either of the groups. LV mass was changed from 189.5 ± 41.3 to 185.6 ± 41.5 g in the intensive therapy group (P = .19) and from 183.8 ± 38.3 to 194.0 ± 46.4 g in the standard therapy group (P < .01). The primary end point of change in LV mass was significantly different between the intensive therapy and the standard therapy group (-3.9 ± 20.2 g vs 10.3 ± 20.4 g; P = .0007). The increase in LV mass index was also significantly greater in the standard therapy group (P = .01). No significant differences in secondary end points (changes in severity of AV disease, LV volumes, ejection fraction and GLS) were observed between the treatment groups.
Conclusions:
Among hypertensive patients with AV disease, intensive hypertensive therapy resulted in a significant reduction in LV hypertrophy, although progression of AV disease was similar between the treatment groups.
Clinical Trial Registration:
http://ClinicalTrials.gov (Number NCT03666351).
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