Abstract 9064: Lower Achieved Systolic Pressure (≤130 mm Hg) is Not Associated With Improved Outcomes in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study
Background: Hypertensive patients with ECG left ventricular hypertrophy (LVH) are at increased risk of cardiovascular (CV) morbidity and mortality. Although regression of ECG LVH is associated with improved CV outcomes in these patients, whether more aggressive reduction of systolic blood pressure (SBP) is associated with greater reduction of CV risk is unclear.
Methods: Risk of stroke, myocardial infarction, CV death, the composite endpoint of these events and all-cause mortality was examined in relation to in-treatment SBP just prior to event in 9193 hypertensive patients with ECG LVH randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141, were compared with patients with in-treatment SBP ≥142 (median SBP at last measurement).
Results: In univariate analyses, compared with in-treatment SBP ≥142, in-treatment SBP between 131 and 141 entered as a time-varying covariate identified patients with significantly lower risk of all events. In contrast, patients with SBP ≤130 had less reduction in MI, stroke and composite endpoint and no significant decrease in CV or all-cause mortality. In multivariate Cox analyses adjusting for treatment, Framingham risk score and in-treatment diastolic BP and Cornell product LVH, SBP of 131 to 141 remained associated with a decreased risk of all endpoints. In contrast, patients who achieved a SBP ≤130 had no significant reduction in risk of MI, stroke or composite endpoint, had a trend to increased CV mortality and a statistically significant 29% increased risk of death.
Conclusions: Achieved SBP ≤130 is not associated with lower CV risk than SBP of 131 to 141 and is associated with a significantly increased risk of death and trend towards increased CV mortality. These findings suggest that treating hypertensive patients with ECG LVH to lower SBP goal may not improve outcome and may be associated with an increased risk of death.
- © 2010 by American Heart Association, Inc.