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Abstract：
BACKGROUND: This study explores the impact of intensive blood pressure (BP) control on left ventricular hypertrophy (LVH) incidence and evaluates the prognostic implications of LVH status (pre-existing/new-onset/persistent/regression) using Systolic Blood Pressure Intervention Trial (SPRINT) Electrocardiogram Data.
METHODS: Poisson regression was used to assess new-onset LVH and LVH regression rates. Multivariable-adjusted Cox proportional hazard models determined the risk of adverse cardiovascular events (ACE), a composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death, alongside safety adverse events.
RESULTS: In 8,016 participants, intensive BP control significantly reduced new-onset LVH (8.27 vs. 14.79 per 1000-person years; adjusted p<0.001) and increased LVH regression (14.89 vs. 11.89 per 1000-person years; adjusted p<0.001). Elevated ACE risk was notable in participants with pre-existing LVH [adjusted HR: 1.94 (95% CI: 1.25-2.99); p = 0.003], new-onset LVH [adjusted 1.74 (95% CI: 1.16-2.60); p = 0.007], and persistent LVH[adjusted HR: 1.96 (95% CI: 1.11-3.46); p = 0.020], compared to those without LVH. Intriguingly, LVH regression attenuated this risk increment [adjusted HR: 1.57 (95% CI: 0.98-2.53); p = 0.062]. Achieving a BP target of < 120/80 mmHg nullified the increased ACE risk in those with pre-existing LVH.
CONCLUSIONS: Intensive BP control is instrumental in both reducing the emergence of LVH and fostering its regression. Pre-existing, new-onset LVH and persistent LV remain a predictor of adverse cardiovascular prognosis, whereas LVH regression and achieving on-treatment BP < 120/80 mmHg in pre-existing LVH individuals may further mitigate residual cardiovascular risk.
BACKGROUND: URL: ClinicalTrials.gov Unique Identifier: NCT01206062.
METHODS: Poisson regression was used to assess new-onset LVH and LVH regression rates. Multivariable-adjusted Cox proportional hazard models determined the risk of adverse cardiovascular events (ACE), a composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death, alongside safety adverse events.
RESULTS: In 8,016 participants, intensive BP control significantly reduced new-onset LVH (8.27 vs. 14.79 per 1000-person years; adjusted p<0.001) and increased LVH regression (14.89 vs. 11.89 per 1000-person years; adjusted p<0.001). Elevated ACE risk was notable in participants with pre-existing LVH [adjusted HR: 1.94 (95% CI: 1.25-2.99); p = 0.003], new-onset LVH [adjusted 1.74 (95% CI: 1.16-2.60); p = 0.007], and persistent LVH[adjusted HR: 1.96 (95% CI: 1.11-3.46); p = 0.020], compared to those without LVH. Intriguingly, LVH regression attenuated this risk increment [adjusted HR: 1.57 (95% CI: 0.98-2.53); p = 0.062]. Achieving a BP target of < 120/80 mmHg nullified the increased ACE risk in those with pre-existing LVH.
CONCLUSIONS: Intensive BP control is instrumental in both reducing the emergence of LVH and fostering its regression. Pre-existing, new-onset LVH and persistent LV remain a predictor of adverse cardiovascular prognosis, whereas LVH regression and achieving on-treatment BP < 120/80 mmHg in pre-existing LVH individuals may further mitigate residual cardiovascular risk.
BACKGROUND: URL: ClinicalTrials.gov Unique Identifier: NCT01206062.
摘要：
背景：本研究使用收缩压干预试验（SPRINT）心电图数据，探讨了强化血压（BP）控制对左心室肥厚（LVH）发生率的影响，并评估了LVH状态（预存在/新发/持续/回归）的预后意义。
方法：使用泊松回归评估新发LVH和LVH回归率。多变量校正Cox比例风险模型确定不良心血管事件（ACE）的风险，心肌梗塞（MI）的复合物，非MI急性冠脉综合征,中风,心力衰竭,或心血管死亡，除了安全不良事件。
结果：在8016名参与者中，强化BP控制显着降低新发LVH（8.27vs.每1000人年14.79；调整后p<0.001），LVH回归增加（14.89vs.每1000人年11.89；调整后p<0.001）。在先前存在LVH的参与者中，ACE风险升高[调整后的HR：1.94（95％CI：1.25-2.99）；p=0.003]，新发LVH[调整后1.74（95%CI：1.16-2.60）；p=0.007]，和持续性LVH[调整后的HR：1.96（95%CI：1.11-3.46）；p=0.020]，与没有LVH的人相比。有趣的是，LVH回归减弱了这一风险增量[调整后的HR：1.57（95％CI：0.98-2.53）；p=0.062]。达到<120/80mmHg的BP目标可以消除先前存在LVH的患者的ACE风险增加。
结论：强化BP控制有助于减少LVH的出现并促进其消退。预先存在的，新发LVH和持续性LV仍然是不良心血管预后的预测因子，而在已经存在的LVH个体中,LVH消退和达到治疗中BP<120/80mmHg可能进一步减轻残余心血管风险.
背景：URL：ClinicalTrials.gov唯一标识符：NCT01206062。
方法：使用泊松回归评估新发LVH和LVH回归率。多变量校正Cox比例风险模型确定不良心血管事件（ACE）的风险，心肌梗塞（MI）的复合物，非MI急性冠脉综合征,中风,心力衰竭,或心血管死亡，除了安全不良事件。
结果：在8016名参与者中，强化BP控制显着降低新发LVH（8.27vs.每1000人年14.79；调整后p<0.001），LVH回归增加（14.89vs.每1000人年11.89；调整后p<0.001）。在先前存在LVH的参与者中，ACE风险升高[调整后的HR：1.94（95％CI：1.25-2.99）；p=0.003]，新发LVH[调整后1.74（95%CI：1.16-2.60）；p=0.007]，和持续性LVH[调整后的HR：1.96（95%CI：1.11-3.46）；p=0.020]，与没有LVH的人相比。有趣的是，LVH回归减弱了这一风险增量[调整后的HR：1.57（95％CI：0.98-2.53）；p=0.062]。达到<120/80mmHg的BP目标可以消除先前存在LVH的患者的ACE风险增加。
结论：强化BP控制有助于减少LVH的出现并促进其消退。预先存在的，新发LVH和持续性LV仍然是不良心血管预后的预测因子，而在已经存在的LVH个体中,LVH消退和达到治疗中BP<120/80mmHg可能进一步减轻残余心血管风险.
背景：URL：ClinicalTrials.gov唯一标识符：NCT01206062。
