Key result
Tight systolic BP control (<130 mm Hg) reduced left ventricular hypertrophy compared to standard control (<140 mm Hg) in patients without (10.8% vs 15.2%) and with (14.1% vs 23.5%) prior CVD.
Why the study?
Does tight blood pressure control (systolic BP target <130 mm Hg) reduce electrocardiographic left ventricular hypertrophy in nondiabetic patients with systolic BP ≥150 mm Hg?
RCT (n=1,111)
Open-label
randomly assigned
Does tight blood pressure control (systolic BP target <130 mm Hg) reduce electrocardiographic left ventricular hypertrophy in nondiabetic patients with systolic BP ≥150 mm Hg?
Tight systolic blood pressure control (<130 mm Hg) reduces left ventricular hypertrophy and cardiovascular events in nondiabetic hypertensive patients regardless of baseline cardiovascular disease status.
Tight BP control merits preference to limit LVH; extends event-driven trials to structural cardiac outcomes in nondiabetic hypertension.
An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target <140 mm Hg (standard control) or <130 mm Hg (tight control). We stratified patients by absence (n=895) or presence (n=216) of established cardiovascular disease at entry. Antihypertensive treatment was open-label and tailored to each patient's needs. After 2-year follow-up, the primary end point of the study, electrocardiographic left ventricular hypertrophy, occurred less frequently in the tight than in the standard control group in the patients without (10.8% versus 15.2%) and with (14.1% versus 23.5%) established cardiovascular disease (P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P=0.016) and with (7.87 versus 11.22 patient-years; P=0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization (P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP<130 mm Hg reduced left ventricular hypertrophy and improved clinical outcomes to a similar extent in patients with hypertension and without established cardiovascular disease.
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Reboldi et al. (2013) conducted an RCT in Hypertension (n=1,111). Tight systolic blood pressure control vs. Standard systolic blood pressure control (<140 mm Hg) was evaluated on electrocardiographic left ventricular hypertrophy. Tight systolic BP control (<130 mm Hg) reduced left ventricular hypertrophy compared to standard control (<140 mm Hg) in patients without (10.8% vs 15.2%) and with (14.1% vs 23.5%) prior CVD.
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