Blood Pressure Lowering in Patients With Central Hypertension: A Randomized Clinical Trial

Area of Science:

• Cardiology
• Hypertension Management
• Clinical Trials

Background:

• Standard cuff blood pressure (BP) is recommended for hypertension management.
• Central BP measurement is proposed as a superior clinical metric.
• This study investigated if central BP control benefits left ventricular mass index (LVMI) reduction.

Purpose of the Study:

• To determine if controlling hypertension via central BP reduces LVMI more than standard cuff BP control.
• To evaluate the efficacy of spironolactone in patients with controlled cuff BP but elevated central BP.

Main Methods:

• A multicenter, open-label, blinded-endpoint trial randomized 301 participants.
• Intervention group received spironolactone 25 mg/day for 24 months; control group received usual care.
• Primary outcome was change in LVMI measured by cardiac MRI; BP measured by clinic, home, and ambulatory monitoring.

Main Results:

• Spironolactone intervention significantly reduced LVMI (-3.2 g/m²; P=0.001) compared to control.
• Both cuff and central BPs were reduced similarly across measurement modes.
• LVMI changes correlated equally with reductions in both cuff and central BP.

Conclusions:

• Spironolactone effectively reduced left ventricular mass in individuals with central hypertension.
• LV mass reduction was associated with both central and cuff BP lowering.
• Central BP monitoring may offer additional insights for hypertension management.