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Updated: Jun 11, 2025

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Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis

Richard Kazibwe1, Muhammad Imtiaz Ahmad2, Sanjay Singh2

  • 1Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|October 3, 2024
PubMed

Insights

Intensive blood pressure lowering significantly reduces the risk of silent myocardial infarction (SMI) and recognized myocardial infarction (RMI) in hypertensive adults. This approach offers broader cardiovascular protection than standard treatment.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Preventive Cardiology

Background:

  • Silent myocardial infarction (SMI) is a significant, often undetected, contributor to cardiovascular morbidity and mortality.
  • The effect of intensive systolic blood pressure (SBP) lowering on SMI risk in hypertensive individuals is not well-established.

Purpose of the Study:

  • To investigate the impact of intensive SBP lowering on the incidence of SMI in adults with hypertension.
  • To compare the effectiveness of intensive SBP lowering versus standard SBP lowering in preventing both SMI and recognized myocardial infarction (RMI).

Main Methods:

  • Post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) involving participants with serial electrocardiograms (ECGs).
  • Intensive SBP lowering aimed for <120 mmHg, compared to a standard goal of <140 mmHg.
  • Incident SMI was defined as new MI on ECG without adjudicated RMI.

Main Results:

  • Intensive SBP lowering reduced SMI incidence (1.1 vs. 2.3 per 1000 person-years; HR: 0.48 [0.27-0.84]).
  • Intensive SBP lowering also reduced RMI risk (4.6 vs. 6.5 per 1000 person-years; HR: 0.71 [0.52-0.95]).
  • No significant difference was found in the strength of association between intensive BP control and the reduction of SMI versus RMI risk.

Conclusions:

  • Intensive systolic blood pressure lowering provides significant benefits beyond preventing recognized myocardial infarction.
  • This intensive approach effectively prevents silent myocardial infarction in hypertensive adults, highlighting its broader cardiovascular protective role.
Abstract

Keywords:
SPRINTblood pressure controlsilent myocardial infarction

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