Lowering systolic blood pressure to ≤130 mmHg increased all-cause mortality by 37% (p=0.005) and cardiovascular mortality by 32% in hypertensive patients aged 55-80 with ECG-LVH in the LIFE study.
Does lowering systolic blood pressure to <130 mmHg increase mortality in middle-aged and older hypertensive patients with ECG-LVH?
Caution is warranted when lowering systolic blood pressure to <130 mmHg in middle-aged and older hypertensive patients with ECG-LVH, as it may be associated with increased all-cause and cardiovascular mortality.
Effect estimate: HR 1.37 for all-cause mortality (37% increase) in LIFE; HR 1.74 and 1.98 for all-cause and cardiac mortality in VALUE for systolic BP <130 mmHg vs 130-139 or ≥140 mmHg (95% CI VALUE HR for 130-139 mmHg: 1.17-2.60; for ≥140 mmHg: 1.06-3.70)
p-value: p=0.005 for all-cause mortality LIFE; 0.08 for cardiovascular mortality LIFE
Left ventricular hypertrophy (LVH) is the most common hypertension-related cardiac disorder. Indeed, it is present in about 50% of patients with hypertension when examined by echocardiography and up to 20-30% when examined by electrocardiogram (ECG). The presence of LVH may be related to safety concerns when treating hypertension because data from large outcome trials in middle-aged and older patients have shown increased mortality if systolic blood pressure (BP) is lowered <130 mmHg. LVH is only briefly mentioned in the 2024 ESC Hypertension Guideline and in the 2025 AHA/ACC Hypertension Guideline. This review therefore discusses the potential consequences of a low target BP in hypertensive patients with LVH. The Losartan Intervention for Endpoint Reduction Study (LIFE) included 9,193 patients 55-80 years old with hypertension and ECG-LVH. A time-varying LIFE analysis showed that achieving systolic BP ≤130 mmHg led to a 37% increase in all-cause mortality (p=0.005) and a 32% increase in cardiovascular mortality (p=0.08) compared to patients who achieved systolic BP of ≥142 mmHg. In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) Trial, which included patients aged ≥50 years with concomitant cardiovascular risk factors, patients with ECG-LVH (n=2,458) who achieved average systolic BP <130 mmHg (n=305) through 4 years had higher all-cause and cardiac mortality than patients with systolic BP 130-139 mmHg (HR=1.74, 95% CIs 1.17-2.60) or systolic BP ≥140 mmHg (HR=1.98, CIs 1.06-3.70). LIFE and VALUE suggested an increased mortality when lowering systolic BP <130 mmHg in patients 50 years and older with ECG-LVH. While further research is needed to better define a target systolic BP in patients with hypertension and ECG-LVH, caution is warranted in lowering systolic BP <130 mmHg in middle-aged and older hypertensive patients with ECG-LVH.
Kjeldsen et al. (Sun,) conducted a review in Hypertensive patients aged 55-80 years with ECG-detected left ventricular hypertrophy (n=9,193). Lowering systolic blood pressure to ≤130 mmHg vs. Systolic blood pressure ≥142 mmHg was evaluated on All-cause mortality (HR 1.37 for all-cause mortality (37% increase) in LIFE; HR 1.74 and 1.98 for all-cause and cardiac mortality in VALUE for systolic BP <130 mmHg vs 130-139 or ≥140 mmHg, 95% CI VALUE HR for 130-139 mmHg: 1.17-2.60; for ≥140 mmHg: 1.06-3.70, p=0.005 for all-cause mortality LIFE; 0.08 for cardiovascular mortality LIFE). Lowering systolic blood pressure to ≤130 mmHg increased all-cause mortality by 37% (p=0.005) and cardiovascular mortality by 32% in hypertensive patients aged 55-80 with ECG-LVH in the LIFE study.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: