Hypertension. 2015 Dec;66(6):1123-9. doi: 10.1161/HYPERTENSIONAHA.115.06236. Epub 2015 Oct 12.

Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Diabetes Mellitus: Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial.

Soliman EZ¹, Byington RP², Bigger JT², Evans G², Okin PM², Goff DC Jr², Chen H².

Author information

1: From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.). esoliman@wakehealth.edu.
2: From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.).

Abstract

Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is a common complication of hypertension. Regression of LVH is achievable by sustained lowering of systolic blood pressure (BP). However, it is unknown whether a strategy aimed at lowering BP beyond that recommended would lower the risk of LVH. We examined the effect of intensive (systolic BP<120 mm Hg), compared with standard (systolic BP<140 mm Hg), BP lowering on the risk of LVH in 4331 patients with diabetes mellitus from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial, a randomized controlled trial. The outcome measures were electrocardiographic LVH defined by Cornell voltage (binary variable) and mean Cornell index (continuous variable). The baseline prevalence of LVH (5.3% versus 5.4%; P=0.91) and the mean Cornell index (1456 versus 1470 µV; P=0.45) were similar in the intensive (n=2154) and standard (n=2177) BP-lowering arms, respectively. However, after median follow-up of 4.4 years, intensive, compared with standard, BP lowering was associated with a 39% lower risk of LVH (odds ratio [95% confidence interval], 0.61[0.43, 0.88]; P=0.008) and a significantly lower adjusted mean Cornell index (1352 versus 1447 µV; P<0.001). The lower risk of LVH associated with intensive BP lowering during follow-up was because of more regression of baseline LVH and lower rate of developing new LVH, compared with standard BP lowering. No interactions by age, sex, or race were observed. These results provide evidence that targeting a systolic BP of <120 mm Hg when compared with <140 mm Hg in patients with hypertension and diabetes mellitus produces a greater reduction in LVH.