Lowering systolic blood pressure below the currently recommended
target can reduce the risk of left ventricular hypertrophy (LVH), the most
common complication of high blood pressure, according to new research.
The study, led by Elsayed Z.
Soliman, M.D., director of the Epidemiological Cardiology Research Center at
Wake Forest Baptist Medical Center, is published in the early online edition of
LVH, the enlargement and
thickening of the walls of the left ventricle, the heart's main pumping chamber, is associated with an increased risk of
heart failure, stroke and even sudden cardiac death. Although doctors have
known that reversal of LVH can be achieved by sustained lowering of systolic blood
pressure – the upper number on a blood pressure reading – it wasn’t known if a
strategy aimed at lowering blood pressure beyond the recommended level would
reduce the risk.
study, the researchers examined the effect of lowering systolic blood pressure to
120mmHg compared to the standard target of 140mmHg on LVH. Data from 4,331 participants
in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood
Pressure trial were included in the analysis. The ACCORD trial, which was
sponsored by the National Heart, Blood and Lung Institute, was a randomized,
multicenter trial involving middle-aged and older patients with Type 2 diabetes
at risk of cardiovascular disease.
half of the study participants were randomly assigned to standard BP regimen
and half were assigned to the intensive version. The baseline prevalence of LVH
was similar in both groups, but after 4.4 years, the intensive-therapy group was
associated with a 39 percent lower risk of LVH as compared to the standard-therapy
group, according to the study authors.
study provides evidence that making less than 120 the target systolic blood
pressure in people with hypertension and diabetes reduces LVH,” Soliman said. “Lowering
blood pressure even below the standard is good for heart muscle.”
This, he added, is in line with the recent
report from the SPRINT trial showing that blood pressure lowering below 120
mmHg reduces cardiovascular events by almost a third, as compared to the target
systolic pressure of 140 mmHg.
“Notably, only stroke risk – not other cardiovascular events – was reduced in the ACCORD trial, which could be
due to certain risks associated with implementing both intensive blood pressure
lowering and intensive blood glucose
lowering in the same patient,” Soliman said.
The ACCORD-BP trial was supported by contracts from the National
Heart, Lung, and Blood Institute (N01-HC-95178, N01-HC-95179,
N01-HC-95180, N01-HC1395181, N01-HC-95182, N01-HC-95183, N01-HC-95184, and
IAA#Y1-HC-9035 and IAA#Y1-HC-1010).
Co-authors of the study
are: Robert P. Byington, Ph.D., Gregory Evans, M.A., Haiying Chen, Ph.D., of
Wake Forest Baptist; Thomas Bigger, M.D., of Columbia University; David C. Goff
Jr., M.D., Ph.D., of Colorado School of Public Health; and Peter M. Okin, M.D.,
of Weill Cornell Medical College.