Finlay A. McAlister, MD
In nondiabetic patients with hypertension, is tight control of systolic blood pressure (SBP) better than usual control for reducing left ventricular hypertrophy (LVH)?
Randomized controlled trial (Cardio-Sis). ClinicalTrials.gov NCT00421863.
Blinded (endpoint adjudication committee and electrocardiogram [ECG] readers).*
Median 2 years.
44 centers in Italy.
1111 patients ≥ 55 years of age (mean age 67 y, 59% women) who had SBP ≥ 150 mm Hg, BP treatment for ≥ 12 weeks, and ≥ 1 of the following risk factors: cigarette smoking, family history of premature cardiovascular (CV) disease, past transient ischemic attack (TIA) or stroke, coronary or peripheral arterial disease, total cholesterol ≥ 5.2 mmol/L, high-density lipoprotein cholesterol < 1.0 mmol/L, or low-density lipoprotein cholesterol ≥ 3.4 mmol/L. Exclusion criteria included fasting glucose ≥ 7.0 mmol/L, diabetes, renal dysfunction, hepatic or hematologic disorders, valvular heart disease, atrial fibrillation, substance misuse, disease that reduces life expectancy, and disorders that affect ECG diagnosis of LVH.
Tight SBP control (< 130 mm Hg) with intensified BP treatment when 1 SBP reading was > 130 mm Hg at any visit (n = 558) or usual SBP control (<140 mm Hg) with less intensive treatment when SBP was < 130 mm Hg (n = 553). Antihypertensive drug treatment was individualized.
Included ECG-diagnosed LVH; a CV composite (mortality, myocardial infarction [MI], stroke, TIA, hospitalization for congestive heart failure, angina pectoris with myocardial ischemia, new-onset atrial fibrillation, coronary revascularization, aortic dissection, occlusive peripheral arterial disease, and renal failure with dialysis); mortality; and baseline-adjusted difference in SBP.
95% (intention-to-treat analysis).
At 2 years, more patients in the tight control than in the usual control group achieved SBP < 130 mm Hg (72% vs 27%, P < 0.001). The main results are in the Table.
In nondiabetic patients with hypertension, tight systolic blood pressure control was better than usual control for reducing left ventricular hypertrophy and cardiovascular events.
Tight vs usual control of systolic blood pressure in nondiabetic patients with hypertension†
†CV = cardiovascular; ECG = electrocardiography; other abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
‡Composite CV endpoint (tight vs usual control) = mortality; myocardial infarction (0.7% vs 1.1%, P = 0.52); stroke or transient ischemic attack (0.7% vs 1.6%, P = 0.16); hospitalization for congestive heart failure (0.5% vs 1.3%, P = 0.21); new-onset atrial fibrillation (1.8% vs 3.8%, P = 0.04); coronary revascularization (0.9% vs 2.7%, P = 0.03); and angina pectoris, aortic dissection, occlusive peripheral arterial disease, or renal failure needing dialysis (comparisons not reported).
McAlister FA. Tight BP control reduced left ventricular hypertrophy in nondiabetic patients with hypertension. Ann Intern Med. ;151:JC5–7. doi: 10.7326/0003-4819-151-10-200911170-02007
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Published: Ann Intern Med. 2009;151(10):JC5-7.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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