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Effect of Hypertension Duration on the Associations Between Intensive Blood Pressure Control and Cardiac, Vascular,
Qianhui Ling1,2, Yue Deng2, Xilan Dong2
1Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing China.
Insights
Intensive systolic blood pressure treatment effectively prevents arterial stiffness in early and long-standing hypertension. However, its benefits for left ventricular hypertrophy and kidney damage did not vary significantly with hypertension duration.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Hypertension poses significant cardiovascular disease risks, often exacerbated by long-standing duration.
- Target organ damage is a key factor in hypertension sequelae.
- The impact of hypertension duration on intensive systolic blood pressure (SBP) treatment benefits for organ damage is not fully understood.
Purpose of the Study:
- To investigate the influence of hypertension duration on the effectiveness of intensive SBP treatment in mitigating cardiac, vascular, and kidney damage.
- To analyze treatment effects across different hypertension durations: ≤5, 5-10, 10-15, and >15 years.
Main Methods:
- The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial included 8442 participants with complete hypertension duration data.
- Participants were randomized to intensive or standard SBP treatment.
- Logistic regression models assessed odds ratios for left ventricular hypertrophy, arterial stiffness, and chronic kidney disease, with interaction testing for hypertension duration.
Main Results:
- Intensive SBP treatment significantly reduced new-onset arterial stiffness in both early (≤5 years) and long-standing (>15 years) hypertension compared to intermediate durations (P for interaction=0.03).
- No significant differences in treatment effects for left ventricular hypertrophy (new-onset or improvement) were observed across hypertension durations (P for interaction >0.05).
- No interaction effects or significant associations with hypertension duration were found for kidney events (P for interaction >0.05).
Conclusions:
- Intensive SBP treatment offers greater benefits in preventing arterial stiffness in early and long-standing hypertension.
- Treatment effects on left ventricular hypertrophy and kidney events did not differ significantly based on hypertension duration.
Background:
Intensive systolic blood pressure (SBP) treatment could mitigate the increased cardiovascular disease risk associated with long-standing hypertension. Target organ damage serves as a critical intermediate phenotype in hypertension-related sequelae. However, the associations of hypertension duration on the cardiac, vascular, and kidney organ damage improvement of intensive SBP treatment remains to be elucidated.
Methods:
A total of 8442 STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5~10 years, 10~15 years, and >15 years. Patients were randomly assigned to intensive or standard SBP treatment groups after enrollment. Odds ratios (ORs) for left ventricular hypertrophy, arterial stiffness, and chronic kidney disease were calculated using a logistic regression model, testing for effect modification by hypertension duration.
Results:
For left ventricular hypertrophy, no evidence showed heterogeneity among groups with different hypertension duration in the treatment effect between intensive versus standard treatment for either new-onset or improvement (both P for interaction >0.05). For arterial stiffness, intensive versus standard SBP treatment showed significantly greater benefits in preventing new-onset arterial stiffness in early-stage (≤5 years: 29.46% versus 36.81%; OR, 0.67 [95% CI, 0.47-0.95]) and long-standing hypertension (>15 years: 30.88% versus 41.23%; OR, 0.62 [95% CI, 0.45-0.84]) compared with the intermediate stage (P for interaction=0.03). For kidney events, no treatment interaction effects or significant associations with hypertension duration were observed (P for interaction >0.05).
Conclusions:
Intensive SBP treatment showed greater benefits in preventing new-onset arterial stiffness in both early-stage (≤5 years) and long-standing (>15 years) hypertension, whereas no heterogeneity was identified among groups with hypertension for left ventricular hypertrophy and kidney events.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.
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