On-Treatment Blood Pressure and Cardiovascular Outcomes in Adults With Hypertension and Left Ventricular Hypertrophy

BACKGROUND Benefits of intensive blood pressure lowering on health outcomes have been demonstrated in high-risk patients. However, little is known about such benefits in patients with left ventricular hypertrophy (LVH). OBJECTIVES This study sought to investigate the association of on-treatment blood pressure with cardiovascular disease (CVD) risk in adults with hypertension and LVH. METHODS From a nationwide health examination database, this study identified 95,545 participants aged 40-79 years who were taking antihypertensive medication and had LVH on baseline electrocardiography. Using Cox models, HRs and 95% 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 120129 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 groupwithDBPof 70-79mmHgwas the reference, multivariable-adjustedHRswere 1.30(95% CI: 1.24-1.37) inthe$90mmHg group, 1.06 (95% CI: 1.01-1.12) in the 80-89 mm Hg group, and 1.08 (95% CI: 0.96 to 1.20) in the <70 mm Hg group. CONCLUSIONS In adults with hypertension and LVH, the risk for CVD events was the lowest at SBP <130 mm Hg and DBP <80 mm Hg. Further randomized trials are warranted to establish optimal blood pressure-lowering strategies for these patients. (C) 2021 by the American College of Cardiology Foundation.

Automated summary

This study found that maintaining blood pressure at SBP <130 mm Hg and DBP <80 mm Hg was associated with the lowest risk for cardiovascular events in adults with hypertension and LVH. Further randomized trials are needed to establish optimal blood pressure-lowering strategies for these patients.