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Hypertension. 2019 Jul 1:HYPERTENSIONAHA11913073. doi: 10.1161/HYPERTENSIONAHA.119.13073. [Epub ahead of print]

Effect of Intensive Blood Pressure Reduction on Left Ventricular Mass, Structure, Function, and Fibrosis in the SPRINT-HEART.

Author information

1
From the Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC (B.U., W.G.H., C.J.R., S.V., D.W.K.).
2
Nephrology Section, Wake Forest School of Medicine, Winston-Salem, NC (M.V.R.).
3
Department of Internal Medicine, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P., T.M.).
4
Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida (J.B.).
5
Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham (S.O.).
6
Epidemiological Cardiology Research Center, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.).
7
Medicine-Nephrology, University of Pennsylvania, Philadelphia (D.L.C., R.T.).
8
Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC (C.A.H.).
9
Division of Hypertension and Nephrology, University of Utah, Salt Lake City (M.E.C.).
10
Cardiovascular Disease, New Brunswick, NJ (W.J.K.).
11
Cardiovascular Disease, Veterans Affairs Medical Center, Washington, DC (V.P.).
12
Medicine-Nephrology, George Washington University School of Medicine, District of Columbia (D.S.R.).
13
Department of Medicine, Case Western Reserve University, Cleveland, OH (S.Z.).

Abstract

In observational studies, left ventricular mass (LVM) and structure are strong predictors of mortality and cardiovascular events. However, the effect of hypertension treatment on LVM reduction and its relation to subsequent outcomes is unclear, particularly at lower blood pressure (BP) targets. In an ancillary study of SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive BP control (target systolic BP target <120 mm Hg) versus standard BP control (<140 mm Hg), cardiac magnetic resonance imaging was performed at baseline and 18-month follow-up to measure: LVM, volumes, ejection fraction, and native T1 mapping for myocardial fibrosis. At baseline, 337 participants were examined (age: 64±9 years, 45% women); 300 completed the 18-month exam (153 intensive control and 147 standard control). In the intensive versus standard BP control group at 18 months, there was no difference in change in LVM (mean±SE =-2.7±0.5 g versus -2.3±0.7 g; P=0.368), ejection fraction, or native T1 ( P=0.79), but there was a larger decrease in LVM/end-diastolic volume ratio (-0.04±0.01 versus -0.01±0.01; P=0.002) a measure of concentric LV remodeling. There were fewer cardiovascular events in the intensive control group, but no significant association between the reduced events and change in LVM or any other cardiac magnetic resonance imaging measure. In SPRINT-HEART, contrary to our hypothesis, there were no significant between-group differences in LVM, function, or myocardial T1 at 18-month follow-up. These results suggests that mediators other than these LV measures contribute to the improved cardiovascular outcomes with intensive BP control.

KEYWORDS:

aging; blood pressure; hypertension; magnetic resonance imaging; ventricular remodeling

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