Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial. Ann Noninvasive Electrocardiol 2024 Nov;29(6):e70018
Date
10/03/2024Pubmed ID
39359164Pubmed Central ID
PMC11447273DOI
10.1111/anec.70018Scopus ID
2-s2.0-85205527516 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Silent myocardial infarction (SMI) frequently goes undetected, yet it is associated with increased cardiovascular morbidity and mortality. The impact of intensive systolic blood pressure (SBP) lowering on the risk of SMI in those with hypertension remains uncertain.
METHODS: In this post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), participants with serial electrocardiograms (ECGs) during the trial were included. SPRINT investigated the benefit of intensive SBP lowering, aiming for < 120 mmHg compared to the standard SBP goal of < 140 mmHg. Incident SMI was defined as evidence of new MI on an ECG without adjudicated recognized myocardial infarction (RMI).
RESULTS: During a median follow-up of 3.9 years, a total of 234 MI events (55 SMI and 179 RMI) occurred. Intensive, compared to standard, SBP lowering resulted in a lower rate of SMI (incidence rate 1.1 vs. 2.3 cases per 1000 person-years, respectively; HR [95% CI]: 0.48 [0.27-0.84]). Similarly, intensive, compared to standard, BP lowering reduced the risk of RMI (incidence rate 4.6 vs. 6.5 cases per 1000 person-years, respectively; HR [95% CI]: 0.71 [0.52-0.95]). No significant differences were noted between the strength of the association of intensive BP control on lowering the risk of SMI and RMI (p-value for HR differences = 0.23).
CONCLUSIONS: This study shows that in adults with hypertension, the benefits of intensive SBP lowering, compared with standard BP lowering, go beyond the prevention of RMI to include the prevention of SMI.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062.
Author List
Kazibwe R, Ahmad MI, Singh S, Chen LY, Soliman EZAuthors
Muhammad Imtiaz Ahmad MBBS Assistant Professor in the Medicine department at Medical College of WisconsinSanjay Singh MD, MBBS Assistant Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAntihypertensive Agents
Blood Pressure
Electrocardiography
Female
Follow-Up Studies
Humans
Hypertension
Incidence
Male
Middle Aged
Myocardial Infarction
Risk Factors
