Intense Systolic BP Intervention Decreases Adverse Outcomes in Malignant LVH

An intensive systolic blood pressure (SBP)-lowering intervention can prevent the development of malignant left ventricular hypertrophy (LVH) and decrease the incidence rate of acute decompensated heart failure (ADHF) events and mortality, according to study findings published in the Journal of the American College of Cardiology.

The Systolic Blood Pressure Intervention Trial (SPRINT) was an open-label, randomized trial of SBP-lowering therapies. For this ancillary study, patients (N=8820) were stratified by LVH status and biomarker levels at baseline and evaluated for the effects of intensive or standard SBP on ADHF event and mortality rates. At baseline, LVH was defined using the Cornell voltage criteria with sex-specific thresholds (women, ≥2200 μV; men, ≥2800 μV), and malignant LVH was defined as LVH plus high-sensitivity cardiac troponin T (hs-cTnT) of at least 14 ng/L or N-terminal pro-B-type natriuretic peptide (NT-proBNP) 125 pg/mL or higher.

The patients had no LVH or elevated biomarkers (n=4361), elevated biomarkers alone (n=3761), LVH alone (n=249), and malignant LVH (n=449) at baseline. The patient cohorts had a mean age of 64 to 72 years, 34% to 68% were women, 13% to 33% had prevalent cardiovascular disease (CVD), and 47% to 51% received the intensive SBP-lowering intervention.

The composite outcome of ADHF events and all-cause mortality occurred among 13.6% of the malignant LVH group, 8.2% of those with elevated biomarkers alone, 5.6% of those with LVH alone, and 1.9% of those without either LVH or elevated biomarkers.

Compared with the cohort without LVH or elevated biomarkers, patients with elevated biomarkers alone (adjusted hazard ratio [aHR], 2.41; 95% CI, 1.76-3.31), LVH alone (aHR, 2.34; 95% CI, 1.04-5.23), and malignant LVH (aHR, 3.88; 95% CI, 2.44-6.18) were associated with increased risk for incident ADHF and all-cause mortality.

For all-cause mortality, only the cohorts with elevated biomarkers and LVH (aHR, 3.69; 95% CI, 2.18-6.24) or without LVH (aHR, 2.15; 95% CI, 1.51-3.07) were associated with increased risk compared with the cohort without either LVH or elevated biomarkers.

Overall, similar risk reductions in both the composite outcome (P =.68) and all-cause mortality alone (P =.88) were observed for standard or intense SBP-lowering interventions. However, due to the higher absolute rates of ADHF events and mortality among the malignant LVH cohort, intensive SBP-lowering therapy associated with a 4-year absolute risk reduction of 4.4% compared with standard SBP-lowering therapy.

Furthermore, for patients without LVH at baseline, risk for incident LVH was decreased with intense SBP-lowering therapy among patients with (odds ratio [OR], 0.51; 95% CI, 0.37-0.69) and without (OR, 0.61; 95% CI, 0.43-0.88) elevated biomarkers compared with standard SBP lowering. Similarly, risk for malignant LVH was reduced with intensive therapy compared with standard therapy (OR, 0.44; 95% CI, 0.30-0.63).

This study was limited by the small sample size of the malignant SVH cohort.

“These findings support intensive SBP lowering as an effective treatment for patients with malignant LVH, and additionally provide preliminary support that intensive SBP lowering may prevent the development of malignant LVH,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.