Differential impacts of blood pressure and lipid lowering on regression of ventricular and arterial mass: the Stop Atherosclerosis in Native Diabetics Trial.
Differential impacts of blood pressure and lipid lowering on regression of ventricular and arterial mass: the Stop Atherosclerosis in Native Diabetics Trial.
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DOI：
10.1161/hypertensionaha.111.172486
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Devereux RB
中科院分区：
文献类型：
--
作者：
Roman MJ;Howard BV;Howard WJ;Mete M;Fleg JL;Lee ET;Devereux RB
The relative impacts of lowering blood pressure vs. lowering low-density lipoprotein cholesterol on regression of ventricular and arterial mass have not been systematically examined. Changes in left ventricular mass and arterial mass (common carotid artery cross-sectional area) following 36 months of simultaneous lowering of systolic blood pressure and low-density lipoprotein cholesterol were examined in the SANDS trial of standard vs. aggressive low-density lipoprotein cholesterol and blood pressure targets in American Indians with type 2 diabetes. The two treatment groups were combined to examine changes in left ventricular and arterial mass over a spectrum of achieved blood pressure and lipid levels. Among the combined group of 413 SANDS participants, systolic blood pressure, low-density lipoprotein cholesterol and left ventricular mass were all significantly reduced, whereas arterial mass significantly increased, following 36 months of therapy (p<0.001 for all). In linear regression models, a decrease in arterial mass was significantly related to achieved systolic blood pressure and, to a lesser extent, achieved low-density lipoprotein cholesterol, following adjustment for important covariates. Left ventricular mass progressively decreased with lower achieved levels of systolic blood pressure, independent of baseline levels of left ventricular mass. In conclusion, achieved levels of systolic blood pressure are important determinants of the extent of regression of arterial and ventricular mass during prolonged therapy in diabetic individuals. Achieved levels of low-density lipoprotein cholesterol influence regression of arterial but not ventricular mass. Our findings suggest there is no threshold of systolic blood pressure below which regression of cardiovascular target organ damage cannot be achieved.
