A significant risk of heart failure and mortality is linked to left ventricular hypertrophy (LVH) accompanied by increases in cardiac biomarkers suggesting myocardial damage and neurohormonal stress (malignant LVH). For a study, researchers sought to ascertain the effects of rigorous systolic blood pressure (SBP) regulation on the avoidance of malignant LVH and its repercussions.

The presence or absence of LVH as determined by a 12-lead ECG and elevations in biomarker levels (high-sensitivity cardiac troponin T≥14 ng/L or N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) at baseline were used to divide the 8,820 participants in the SPRINT (Systolic Blood Pressure Intervention Trial) study into groups. They compared the impact of intensive vs. conventional SBP reduction on the incidence and remission of malignant LVH, as well as the rates of acute decompensated heart failure (ADHF) episodes and mortality.

The combined LVH/biomarker groups that were randomly assigned to intense SBP lowering saw comparable relative decreases in ADHF occurrences and mortality (P for interaction = 0.68). Individuals with baseline malignant LVH (n = 449) saw an absolute risk reduction in ADHF episodes and mortality of 4.4% (95% CI: 5.2% to 13.9%), whereas participants with baseline nonelevated biomarkers and no LVH experienced an absolute risk reduction of 1.2% (95% CI: 0.0%–2.5%). Over a period of 2 years, the incidence of malignant LVH was also decreased by intensive SBP reduction (2.5% vs. 1.1%; OR: 0.44; 95% CI: 0.30-0.63).

Among SPRINT individuals with baseline malignant LVH, intensive SBP lowering avoided malignant LVH and may offer a significant absolute risk reduction in the composite of ADHF occurrences and mortality.

Reference: jacc.org/doi/10.1016/j.jacc.2022.08.735