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Upadhya B, Rocco MV, Pajewski NM, Morgan T, Blackshear J, Hundley WG, Oparil S, Soliman EZ, Cohen DL, Hamilton CA, Cho ME, Kostis WJ, Papademetriou V, Rodriguez CJ, Raj DS, Townsend R, Vasu S, Zamanian S, Kitzman DW. Effect of Intensive Blood Pressure Reduction on Left Ventricular Mass, Structure, Function, and Fibrosis in the SPRINT-HEART. Hypertension 2019; 74:276-284. [PMID: 31256724 PMCID: PMC7098010 DOI: 10.1161/hypertensionaha.119.13073] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/25/2019] [Indexed: 01/10/2023]
Abstract
In observational studies, left ventricular mass (LVM) and structure are strong predictors of mortality and cardiovascular events. However, the effect of hypertension treatment on LVM reduction and its relation to subsequent outcomes is unclear, particularly at lower blood pressure (BP) targets. In an ancillary study of SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive BP control (target systolic BP target <120 mm Hg) versus standard BP control (<140 mm Hg), cardiac magnetic resonance imaging was performed at baseline and 18-month follow-up to measure: LVM, volumes, ejection fraction, and native T1 mapping for myocardial fibrosis. At baseline, 337 participants were examined (age: 64±9 years, 45% women); 300 completed the 18-month exam (153 intensive control and 147 standard control). In the intensive versus standard BP control group at 18 months, there was no difference in change in LVM (mean±SE =-2.7±0.5 g versus -2.3±0.7 g; P=0.368), ejection fraction, or native T1 (P=0.79), but there was a larger decrease in LVM/end-diastolic volume ratio (-0.04±0.01 versus -0.01±0.01; P=0.002) a measure of concentric LV remodeling. There were fewer cardiovascular events in the intensive control group, but no significant association between the reduced events and change in LVM or any other cardiac magnetic resonance imaging measure. In SPRINT-HEART, contrary to our hypothesis, there were no significant between-group differences in LVM, function, or myocardial T1 at 18-month follow-up. These results suggests that mediators other than these LV measures contribute to the improved cardiovascular outcomes with intensive BP control.
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Affiliation(s)
- Bharathi Upadhya
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael V. Rocco
- Department of Internal Medicine, Nephrology Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tim Morgan
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - William Greg Hundley
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Debbie L. Cohen
- Medicine-Nephrology, University of Pennsylvania, Philadelphia, PA
| | - Craig A. Hamilton
- Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC
| | - Monique E. Cho
- Division of Hypertension and Nephrology, University of Utah, Salt Lake City, UT
| | | | | | - Carlos J. Rodriguez
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dominic S Raj
- Medicine-Nephrology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Ray Townsend
- Medicine-Nephrology, University of Pennsylvania, Philadelphia, PA
| | - Sujethra Vasu
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sara Zamanian
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Dalane W. Kitzman
- Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, Winston-Salem, NC
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Hydrochlorothiazide and alternative diuretics versus renin-angiotensin system inhibitors for the regression of left ventricular hypertrophy: a head-to-head meta-analysis. J Hypertens 2019; 36:1247-1255. [PMID: 29465713 DOI: 10.1097/hjh.0000000000001691] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Found in 36-41% of hypertension, elevated left ventricular mass (LVM) independently predicts cardiovascular events and total mortality. Conversely, drug-induced regression of LVM predicts improved outcomes. Previous studies have favored renin-angiotensin system inhibitors (RASIs) over other antihypertensives for reducing LVM but ignored differences among thiazide-type diuretics. From evidence regarding potency, cardiovascular events, and electrolytes, we hypothesized a priori that 'CHIP' diuretics [CHlorthalidone, Indapamide and Potassium-sparing Diuretic/hydrochlorothiazide (PSD/HCTZ)] would rival RASIs for reducing LVM. METHOD AND RESULTS Systematic review yielded 12 relevant double-blind randomized trials. CHIPs were more closely associated with reduced LVM than HCTZ (P = 0.004), indicating that RASIs must be compared with each diuretic separately. Publication bias favoring RASIs was corrected by cumulative analysis. For reducing LVM, HCTZ tended to be less effective than RASIs. However, the following surpassed RASIs: chlorthalidone Hedge's G: -0.37 (95% CI -0.72 to -0.02), P = 0.036; indapamide -0.20 (-0.39 to -0.01), P = 0.035; all CHIPs combined (with 61% of patients in one trial) -0.25 (-0.41to -0.09), P = 0.002. Statistical significance (P < 0.05) did not depend on any one trial. CHIPs reduction in LVM was 37% greater than that from RASIs. CHIPs superiority tended to increase with trial duration, from a negligible effect at 0.5 year to a maximal effect at 0.9-1.0 years: -0.26 (-0.43 to -0.09), P = 0.003. Fifty-eight percent of patients had information on echocardiographic components of LVM: relative to RASIs, CHIPs significantly reduced end-diastolic LV internal dimension (EDLVID): -0.18 (-0.36 to -0.00), P = 0.046. Strength of evidence favoring CHIPs over RASIs was at least moderate. CONCLUSION In these novel results in patients with hypertension, CHIPs surpassed RASIs for reducing LVM and EDLVID.
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Roush GC, Abdelfattah R, Song S, Ernst ME, Sica DA, Kostis JB. Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium-sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:1507-1515. [PMID: 30251403 DOI: 10.1111/jch.13386] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Left ventricular hypertrophy develops in 36%-41% of hypertensive patients and independently predicts cardiovascular events and total mortality. Moreover, drug-induced reduction in left ventricular mass (LVM) correlates with improved prognosis. The optimal thiazide-type diuretic for reducing LVM is unknown. Evidence regarding potency, cardiovascular events, sodium, and potassium suggested the hypothesis that "CHIP" diuretics (CHlorthalidone, Indapamide, and Potassium-sparing diuretic/hydrochlorothiazide [PSD/HCTZ]) would reduce LVM more than HCTZ. Systematic searches of five databases were conducted. Among the 38 randomized trials, a 1% reduction in systolic blood pressure (SBP) predicted a 1% reduction in LVM, P = 0.00001. CHIP-HCTZ differences in reducing LVM differed across trials (ie, heterogeneity), making interpretation uncertain. However, among the 28 double-blind trials, heterogeneity was undetectable, and HCTZ reduced LVM (percent reduction [95% CI]) by -7.3 (-10.4, -4.2), P < 0.0001. CHIP diuretics surpassed HCTZ in reducing LVM: chlorthalidone -8.2 (-14.7, -1.6), P = 0.015; indapamide -7.5 (-12.7, -2.3), P = 0.005; and all CHIP diuretics combined -7.7 (-12.2, -3.1), P < 0.001. The comparison of PSD/HCTZ with HCTZ had low statistical power but favored PSD/HCTZ: -6.0 (-14.1, +2.1), P = 0.149. Thus, compared to HCTZ, CHIP diuretics had twice the effect on LVM. CHIP diuretics did not surpass HCTZ in reducing systolic or diastolic blood pressure: -0.3 (-5.0, +4.3) and -1.6 (-5.6, +2.4), respectively. The strength of evidence that CHIP diuretics surpass HCTZ for reducing LVM was high (GRADE criteria). In conclusion, these novel results have demonstrated that CHIP diuretics reduce LVM 2-fold more than HCTZ among hypertensive patients. Although generally related to LVM, blood pressure fails to explain the superiority of CHIP diuretics for reducing LVM.
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Affiliation(s)
| | | | - Steven Song
- SUNY Downstate Medical Center, New York, New York
| | | | - Domenic A Sica
- Department of Medicine and Pharmacology, Virginia Commonwealth University, Richmond, Virginia
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Baldo MP, Rodrigues SL, Mill JG. High salt intake as a multifaceted cardiovascular disease: new support from cellular and molecular evidence. Heart Fail Rev 2016; 20:461-74. [PMID: 25725616 DOI: 10.1007/s10741-015-9478-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Scientists worldwide have disseminated the idea that increased dietary salt increases blood pressure. Currently, salt intake in the general population is ten times higher than that consumed in the past and at least two times higher than the current recommendation. Indeed, a salt-rich diet increases cardiovascular morbidity and mortality. For a long time, however, the deleterious effects associated with high salt consumption were only related to the effect of salt on blood pressure. Currently, several other effects have been reported. In some cases, the deleterious effects of high salt consumption are independently associated with other common risk factors. In this article, we gather data on the effects of increased salt intake on the cardiovascular system, from infancy to adulthood, to describe the route by which increased salt intake leads to cardiovascular diseases. We have reviewed the cellular and molecular mechanisms through which a high intake of salt acts on the cardiovascular system to lead to the progressive failure of a healthy heart.
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Affiliation(s)
- Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES, 29042-755, Brazil,
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Zhang Y, Liou WW, Gupta V. Modeling of high sodium intake effects on left ventricular hypertrophy. Comput Biol Med 2015; 58:31-9. [PMID: 25601615 DOI: 10.1016/j.compbiomed.2014.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/06/2014] [Accepted: 12/18/2014] [Indexed: 01/19/2023]
Abstract
Many clinical studies suggest that chronic high sodium intake contributes to the development of essential hypertension and left ventricular (LV) hypertrophy. In the present study, a system-level computer model has been developed to simulate the long-term effects of increased sodium intake on the LV mechanical functions and the body-fluid homeostasis. The new model couples a cardiovascular hemodynamics function model with an explicit account of the LV wall thickness variation and a long-term renal system model. The present model is validated with published results of clinical studies. The results suggest that, with increased sodium intake, the renal system function, the plasma hormone concentrations, and the blood pressure adapt to new levels of equilibrium. The LV work output and the relative wall thickness increase due to the increase of sodium intake. The results of the present model match well with the patient data.
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Affiliation(s)
- Yan Zhang
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, Michigan, USA
| | - William W Liou
- Department of Mechanical and Aerospace Engineering, Western Michigan University, Kalamazoo, Michigan, USA.
| | - Vishal Gupta
- Borgess Medical Center, Borgess Research Institute, Kalamazoo, Michigan, USA
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de Simone G, Devereux RB, Izzo R, Girfoglio D, Lee ET, Howard BV, Roman MJ. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc 2013; 2:e000144. [PMID: 23744404 PMCID: PMC3698775 DOI: 10.1161/jaha.113.000144] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Hypertensive left ventricular mass (LVM) is expected to decrease during antihypertensive therapy, based on results of clinical trials. Methods and Results We assessed 4‐year change of echocardiographic LVM in 851 hypertensive free‐living participants of the Strong Heart Study (57% women, 81% treated). Variations of 5% or more of the initial systolic blood pressure (SBP) and LVM were categorized for analysis. At baseline, 23% of men and 36% of women exhibited LV hypertrophy (LVH, P<0.0001). At the follow‐up, 3% of men and 10% of women had regression of LVH (P<0.0001 between genders); 14% of men and 15% of women, free of baseline LVH, developed LVH. There was an increase in LVM over time, more in men than in women (P<0.001). Participants whose LVM did not decrease had similar baseline SBP and diastolic BP, but higher body mass index (BMI), waist/hip ratio, heart rate (all P<0.008), and urinary albumin/creatinine excretion (P<0.001) than those whose LVM decreased. After adjusting for field center, initial LVM index, target BP, and kinship degree, lack of decrease in LVM was predicted by higher baseline BMI and urinary albumin/creatinine excretion, independently of classes of antihypertensive medications, and significant effects of older age, male gender, and percentage increase in BP over time. Similar findings were obtained in the subpopulation (n=526) with normal BP at follow‐up. Conclusions In a free‐living population, higher BMI is associated with less reduction of hypertensive LVH; lack of reduction of LVM is independent of BP control and of types of antihypertensive treatment, but is associated with renal damage.
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Affiliation(s)
- Giovanni de Simone
- Department of Translational Medical Sciences, Federico II University, Napoli, Italy.
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Susic D, Frohlich ED. Salt consumption and cardiovascular, renal, and hypertensive diseases: clinical and mechanistic aspects. Curr Opin Lipidol 2012; 23:11-6. [PMID: 22123673 DOI: 10.1097/mol.0b013e32834d9c52] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review will discuss some relevant and novel studies on the relationship between sodium intake and cardiovascular structure and function, focusing on blood pressure independent effects of salt on the heart, arteries, and kidneys. RECENT FINDINGS Several new reports clearly demonstrate the role of high dietary salt in mediating cardiovascular and renal morbidity and mortality including stroke, myocardial infarction, arterial stiffening, heart failure, and renal insufficiency. A number of recent studies also indicate that in addition to increased sodium intake, simultaneous decrease in potassium intake may aggravate adverse cardiovascular and renal manifestations. SUMMARY It is now generally accepted that there is a direct positive correlation between dietary salt and arterial pressure. Thus, the beneficial effects of dietary salt reduction are, at least in part, due to a decrease in arterial pressure. Furthermore, the beneficial, pressure-independent effects of sodium restriction on the heart, blood vessels, and kidneys are being increasingly recognized, but not generally appreciated.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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