Ideal Blood Pressure in Adults With Hypertension and LV Hypertrophy

Oct 04, 2021
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Authors:
Lee HH, Lee H, Cho SM, et al.
Citation:
On-Treatment Blood Pressure and Cardiovascular Outcomes in Adults With Hypertension and Left Ventricular Hypertrophy. J Am Coll Cardiol 2021;78:1485-1495.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • The risk for CVD events was the lowest at SBP <130 mm Hg or DBP <80 mm Hg without evidence of J-curve association.
  • Of note, BP levels <120/<70 mm Hg were not associated with additional reductions in CVD risk.
  • Additional prospective randomized studies are indicated to establish optimal BP-lowering strategies and targets for patients with hypertension and LVH.

Study Questions:

What is the association of on-treatment blood pressure (BP) with cardiovascular disease (CVD) risk in adults with hypertension and left ventricular hypertrophy (LVH)?

Methods:

The investigators identified 95,545 participants aged 40-79 years from a nationwide health examination database who were taking antihypertensive medication and had LVH on baseline electrocardiography. Using Cox models, hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events were calculated according to systolic blood pressure (SBP) or diastolic blood pressure (DBP).

Results:

Over a median follow-up of 11.5 years, 12,035 new CVD events occurred. An SBP of <130 mm Hg and DBP of <80 mm Hg were associated with the lowest risk for CVD events in cubic spline models. When the group with SBP of 120 mm Hg was the reference, multivariable-adjusted HRs were 1.31 (95% CI, 1.24-1.38) in the ≥140 mm Hg group, 1.08 (95% CI, 1.02-1.15) in the 130-139 mm Hg group, and 1.03 (95% CI, 0.93-1.15) in the <120 mm Hg group. Likewise, when the group with DBP of 70-79 mm Hg was the reference, multivariable-adjusted HRs were 1.30 (95% CI, 1.24-1.37) in the ≥90 mm group, 1.06 (95% CI, 1.01-1.12) in the 80-89 mm Hg group, and 1.08 (95% CI, 0.96-1.20) in the <70 mm Hg group.

Conclusions:

The authors concluded that in adults with hypertension and LVH, the risk for CVD events was the lowest at SBP <130 mm Hg and DBP <80 mm Hg.

Perspective:

This nationwide study of Korean adults with hypertension and LVH reports that the risk for CVD events was the lowest at SBP <130 mm Hg or DBP <80 mm Hg without evidence of J-curve association. In contrast, SBP ≥130 mm Hg or DBP ≥80 mm Hg was associated with a higher CVD risk. Of note, BP levels <120/<70 mm Hg were not associated with additional reductions in CVD risk. Additional prospective randomized studies are indicated to establish optimal BP-lowering strategies and targets for patients with hypertension and LVH.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Diagnostic Imaging, Electrocardiography, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Primary Prevention, Risk, Vascular Diseases


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