Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).
Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).
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DOI：
10.1161/circulationaha.117.028441
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发表时间：
2017-08-01
期刊：
影响因子：
37.8
通讯作者：
SPRINT Research Study Group
中科院分区：
文献类型：
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作者：
Soliman EZ;Ambrosius WT;Cushman WC;Zhang ZM;Bates JT;Neyra JA;Carson TY;Tamariz L;Ghazi L;Cho ME;Shapiro BP;He J;Fine LJ;Lewis CE;SPRINT Research Study Group
目前尚不清楚，在高血压患者中，强化降压（BP）是否会导致左心室肥大（LVH）风险进一步降低，以及降低LVH风险是否解释了该人群中强化降压的心血管疾病（CVD）获益。这项分析包括来自Syphilis血压干预（SPRINT）试验的8，164名高血压但无糖尿病的参与者（平均年龄67.9岁，35.3%女性，31.2%黑人）; 4，086名随机分配到强化降压组（目标收缩压<120 mmHg），4，078名分配到标准降压组（目标收缩压<140 mmHg）。在中位随访3.81年期间，比较两个治疗组之间LVH的进展和消退（根据基线和每半年记录的标准12导联心电图得出的Cornell电压标准）。在调整LVH作为随时间变化的协变量之前和之后，比较了强化（与标准）降压对SPRINT主要CVD结局（心肌梗死、急性冠脉综合征、卒中、心力衰竭和CVD死亡的复合终点）的影响。在基线无LVH的SPRINT参与者中（n= 7，559），强化（与标准）降压与LVH发生风险降低46%相关（HR=0.54，95%CI：0.43 - 0.68）。同样，在基线LVH的SPRINT参与者中（n=605，7.4%），那些被分配到强化（与标准）降压组的参与者LVH消退/改善的可能性高66%（HR=1.66，95%CI：1.31至2.11）。调整LVH作为时变协变量并没有显著减弱强化BP治疗对CVD事件的影响（调整LVH作为时变协变量前后，强化与标准BP降低对CVD的HR（95%CI）分别为0.76（0.64，0.90）和0.77（0.65，0.91））。在高血压但无糖尿病的患者中，与标准降压（目标收缩压<140 mmHg）相比，强化降压（目标收缩压<120 mmHg）导致无LVH患者新发LVH的发生率较低，而已有LVH患者LVH消退的发生率较高。这种对LVH的有利影响并不能解释SPRINT试验中与强化降压相关的大部分CVD事件减少。
It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of Left ventricular hypertrophy (LVH) in patients with hypertension, and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. This analysis included 8,164 participants (mean age 67.9 years, 35.3% women, 31.2% blacks) with hypertension but no diabetes from the Systolic Blood Pressure Intervention (SPRINT) Trial; 4,086 randomly assigned to intensive BP lowering (target systolic BP<120mmHg) and 4,078 assigned to standard BP lowering (target systolic BP <140mmHg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead electrocardiograms recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (vs. standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjusting for LVH as a time-varying covariate. Among SPRINT participants without baseline LVH (n=7,559), intensive (vs. standard) BP lowering was associated with a 46% lower risk of developing LVH (HR=0.54, 95%CI: 0.43 to 0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (vs. standard) BP lowering were 66% more likely to regress/improve their LVH (HR=1.66, 95%CI: 1.31 to 2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (HR (95%CI) of intensive vs. standard BP lowering on CVD: 0.76(0.64,0.90) and 0.77(0.65,0.91) before and after adjusting for LVH as a time-varying covariate, respectively). Among patients with hypertension but no diabetes, intensive BP lowering (target systolic BP<120 mmHg), compared with standard BP lowering (target systolic BP<140 mmHg), resulted in lower rates of developing new LVH in those without LVH, and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial.