Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial

摘要

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 (SBP). 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 (SBP<120 mmHg), compared to standard (SBP<140 mmHg), BP lowering on the risk of LVH in 4,331 patients with diabetes from the from the ACCORD BP trial, a randomized controlled trial. The outcomes measures were electrocardiographic LVH defined by Cornell voltage (binary variable) and mean Cornell index (continuous variable). The baseline prevalence of LVH (5.3% vs. 5.4%, p= 0.91) and the mean Cornell index (1456 µV vs. 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 to standard, BP lowering was associated with a 39% lower risk of LVH (odds ratio(95% CI):0.61(0.43, 0.88); p=0.008) and a significantly lower adjusted mean Cornell index (1352 µV vs. 1447 µV; p<0.001). The lower risk of LVH associated with intensive BP lowering during follow up was due to more regression of baseline LVH and lower rate of developing new LVH, compared to standard BP lowering. No interactions by age, sex, or race were observed. These results provide evidence that targeting a systolic BP<120 mmHg, as compared with <140 mm Hg, in patients with hypertension and diabetes produces a greater reduction in LVH.>Clinical Trial Registration: number,