Intensive lowering of systolic blood pressure can prevent malignant LVH: JACC

A new study conducted by Simon Ascher and team found that among SPRINT (Systolic Blood Pressure Intervention Trial) individuals with baseline malignant left ventricular hypertrophy (LVH), intensive systolic blood pressure (SBP) lowering avoided malignant LVH and may offer a significant absolute risk reduction in the composite of acute decompensated heart failure (ADHF) occurrences and mortality. The findings of this study were published in the Journal of the American College of Cardiology.

Malignant LVH, which combines left ventricular hypertrophy with increases in cardiac biomarkers showing myocardial damage and neurohormonal stress, is linked to a significant risk of heart failure and mortality. So, the purpose of this study was to find out how intensive systolic blood pressure management affected the prevention of malignant LVH and its effects.

The presence or absence of LVH as determined by a 12-lead ECG and elevations in biomarker levels (high-sensitivity cardiac troponin T 14 ng/L or N-terminal pro-B-type natriuretic peptide 125 pg/mL) at baseline were used to divide the 8,820 participants in the SPRINT study into groups. We compared the impact of intensive vs. conventional SBP reduction on the incidence and remission of malignant LVH, acute decompensated heart failure episodes, and mortality rates.

The key findings of this study were:

1. Similar proportionate decreases in ADHF events and mortality were seen throughout the combined LVH/biomarker groups after randomization to aggressive SBP lowering.

2. Those with baseline malignant LVH (n = 449) saw a 4.4% absolute risk reduction in ADHF episodes and mortality over a 4-year period, whereas participants with non-elevated biomarkers and no LVH experienced a 1.2% absolute risk reduction.

3. Over a two-year period, the incidence of malignant LVH was decreased by intensive SBP reduction.

In conclusion, the investigation found that more aggressively decreasing systolic blood pressure to a goal of less than 120 mm Hg decreased both the incidence of malignant LVH and the progression of heart failure or mortality in people with malignant LVH compared to lowering it to under 140 mm Hg.

Reference: 

Ascher, S. B., de Lemos, J. A., Lee, M., Wu, E., Soliman, E. Z., Neeland, I. J., Kitzman, D. W., Ballantyne, C. M., Nambi, V., Killeen, A. A., Ix, J. H., Shlipak, M. G., & Berry, J. D. (2022). Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy. In Journal of the American College of Cardiology (Vol. 80, Issue 16, pp. 1516–1525). Elsevier BV. https://doi.org/10.1016/j.jacc.2022.08.735