Effect of Hypertension Duration on the Associations Between Intensive Blood Pressure Control and Cardiac, Vascular, and Kidney Organ Damage.

BACKGROUND

Intensive systolic blood pressure (SBP) treatment could mitigate the increased cardiovascular disease risk associated with long-standing hypertension. Target organ damage serves as a critical intermediate phenotype in hypertension-related sequelae. However, the associations of hypertension duration on the cardiac, vascular, and kidney organ damage improvement of intensive SBP treatment remains to be elucidated.

METHODS

A total of 8442 STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5~10 years, 10~15 years, and >15 years. Patients were randomly assigned to intensive or standard SBP treatment groups after enrollment. Odds ratios (ORs) for left ventricular hypertrophy, arterial stiffness, and chronic kidney disease were calculated using a logistic regression model, testing for effect modification by hypertension duration.

RESULTS

For left ventricular hypertrophy, no evidence showed heterogeneity among groups with different hypertension duration in the treatment effect between intensive versus standard treatment for either new-onset or improvement (both P for interaction >0.05). For arterial stiffness, intensive versus standard SBP treatment showed significantly greater benefits in preventing new-onset arterial stiffness in early-stage (≤5 years: 29.46% versus 36.81%; OR, 0.67 [95% CI, 0.47-0.95]) and long-standing hypertension (>15 years: 30.88% versus 41.23%; OR, 0.62 [95% CI, 0.45-0.84]) compared with the intermediate stage (P for interaction=0.03). For kidney events, no treatment interaction effects or significant associations with hypertension duration were observed (P for interaction >0.05).

CONCLUSIONS

Intensive SBP treatment showed greater benefits in preventing new-onset arterial stiffness in both early-stage (≤5 years) and long-standing (>15 years) hypertension, whereas no heterogeneity was identified among groups with hypertension for left ventricular hypertrophy and kidney events.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.