Physicians' Academy for Cardiovascular Education

Intensive SBP lowering reduces incident malignant left ventricular hypertrophy

Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy

Literature - Ascher SB, de Lemos JA, Lee M, et al. - J Am Coll Cardiol. 2022;80:1516–1525. doi:10.1016/j.jacc.2022.08.735

Introduction and methods


Left ventricular hypertrophy (LVH) is associated with incident HF and death. This risk is particularly high in the subgroup with malignant LVH, which is defined as LVH in combination with high hs-cTnT or NT-proBNP [1-5]. The SPRINT trial previously showed that targeting a SBP <120 mmHg compared with <140 mmHg resulted in lower rates of ADHF and death, among patients with hypertension and at high CVD risk [6]. Moreover, SPRINT and other clinical trials showed that intensive blood pressure lowering prevents and may lead to the regression of malignant LVH [7-9]. However, it is unclear whether intensive blood pressure lowering can reduce the risk of acute decompensated HF (ADHF) events and death when malignant LVH is present.

Aim of the study

This ancillary analysis of SPRINT investigated whether intensive versus standard SBP lowering would reduce ADHF events and death in patients with malignant LVH present at baseline. Whether intensive SBP lowering could prevent the development of malignant LVH was assessed as well .


In the open-label SPRINT trial individuals aged ≥50 years with SBP 130 to 180 mmHg and at high CVD risk were assigned to a SBP target of either <140 mm Hg (standard-treatment group) or < 120 mm Hg (intensive-treatment group).

In this ancillary analysis, participants (n=8,820) from SPRINT were divided into 4 groups based on the presence or absence of LVH assessed by ECG, and elevations in biomarker levels; either hs-cTnT ≥14 ng/L or NT-proBNP ≥125 pg/mL at baseline: 1) no LVH and no elevated cardiac biomarkers (LVH -, biomarker -), n=4361; 2) no LVH with elevated cardiac biomarkers (LVH -, biomarker +), n=3761; 3) LVH with non-elevated cardiac biomarkers (LVH +, biomarker -), n=249; and 4) LVH with elevated cardiac biomarkers (LVH +, biomarker +), n=449. The effects of intensive versus standard SBP lowering on rates of ADHF events and death (over 4 years) and the incidence and regression of LVH and malignant LVH (over 2 years) were determined in the 4 groups.


The primary outcome of this analysis was the composite of incident ADHF events and all-cause mortality. Secondary outcomes were all-cause mortality, the incidence and regression of malignant LVH, and the incidence and regression of LVH.

Main results

Associations between LVH/biomarker categories and incident ADHF events and mortality

Effects of intensive versus standard SBP lowering on ADHF events and all-cause mortality

Effects of intensive vs standard SBP lowering on LVH outcomes


In this analysis of the SPRINT trial, intensive SBP lowering compared with standard SBP lowering reduced the risk of incident malignant LVH among patients with hypertension and at high CVD risk. Intensive SBP lowering led to similar risk reductions in ADHF and death across the 4 LVH/biomarker groups. Relative and absolute risk reductions with intensive SBP lowering in the malignant LVH group did not reach statistical significance.


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Find this article online at J Am Coll Cardiol.

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