Achieving a Systolic Blood Pressure Below 130 mmHg Reduces the Incidence of Cardiovascular Events in Hypertensive Patients with Echocardiographic Left Ventricular Hypertrophy

Abstract

Background: Recent reports have evidenced an increased mortality rate in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) achieving systolic blood pressure (SBP) <130mmHg. However, to the best of our knowledge, the actual effects of BP reduction to the ≤130/80mmHg target on the incidence of cardiovascular events in hypertensive patients with a diagnosis of LVH based on echocardiographic-criteria (Echo-LVH) have never been determined. Methods: In order to fill this long-standing knowledge gap, we harnessed a population of 9511 hypertensive patients, followed-up for 33.6 [IQR 7.9-72.7] months. The population was divided into six groups according to the average SBP achieved during the follow-up (≤130, 130-to-139, and ≥140mmHg) and absence/presence of Echo-LVH. The primary endpoint was a composite of fatal or non-fatal myocardial infarction and stroke, sudden cardiac death, heart failure requiring hospitalization, revascularization, and carotid stenting. Secondary endpoints included atrial fibrillation and transient ischemic attack. Results: During the follow-up, achieved SBP and diastolic BP (DBP) were comparable between patients with and without Echo-LVH. Strikingly, the rate of primary and secondary endpoints was significantly higher in patients with Echo-LVH and SBP>130mmHg, reaching the highest rate in the Echo-LVH group with SBP≥140mmHg. By separate Cox multivariable regressions, after adjusting for potential confounders, both primary and secondary endpoints were significantly associated with SBP≥140mmHg and Echo-LVH. Instead, DBP reduction ≤80mmHg was associated with a significant increased rate of secondary events. Conclusions:In hypertensive patients with Echo-LVH, achieving an average in-treatment SBP target ≤130mmHg has a beneficial prognostic impact on incidence of cardiovascular events.

Dysfunctional mitochondria elicit bioenergetic decline in the aged heart

“…Standard echocardiography reveals modifications in cardiac dimensions and wall thickness. The prevalence of left ventricular hypertrophy (LVH) increases with age, even in the absence of hypertension [1][2][3][4][5] . Diastolic dysfunction is a prevailing feature, evidenced by compromised LV filling in early diastolic phase (peak E wave), potentially due to fibrosis and reduced ventricular elasticity [6] .…”