Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial
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 th...
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Wiley
2024-11-01
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| Series: | Annals of Noninvasive Electrocardiology |
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| Online Access: | https://doi.org/10.1111/anec.70018 |
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| author | Richard Kazibwe Muhammad Imtiaz Ahmad Sanjay Singh Lin Y. Chen Elsayed Z. Soliman |
| author_facet | Richard Kazibwe Muhammad Imtiaz Ahmad Sanjay Singh Lin Y. Chen Elsayed Z. Soliman |
| author_sort | Richard Kazibwe |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-008bd1e43dba4932bcce858485ec1be8 |
| institution | Kabale University |
| issn | 1082-720X 1542-474X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Noninvasive Electrocardiology |
| spelling | doaj-art-008bd1e43dba4932bcce858485ec1be82024-11-27T11:54:36ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2024-11-01296n/an/a10.1111/anec.70018Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled TrialRichard Kazibwe0Muhammad Imtiaz Ahmad1Sanjay Singh2Lin Y. Chen3Elsayed Z. Soliman4Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem North Carolina USADepartment of Internal Medicine, Section on Hospital Medicine Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Internal Medicine, Section on Hospital Medicine Medical College of Wisconsin Milwaukee Wisconsin USALillehei Heart Institute and Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USAEpidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Cardiovascular Section Wake Forest School of Medicine Winston‐Salem North Carolina USAABSTRACT 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.https://doi.org/10.1111/anec.70018blood pressure controlsilent myocardial infarctionSPRINT |
| spellingShingle | Richard Kazibwe Muhammad Imtiaz Ahmad Sanjay Singh Lin Y. Chen Elsayed Z. Soliman Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial Annals of Noninvasive Electrocardiology blood pressure control silent myocardial infarction SPRINT |
| title | Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial |
| title_full | Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial |
| title_fullStr | Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial |
| title_full_unstemmed | Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial |
| title_short | Effect of Intensive Blood Pressure Lowering on the Risk of Incident Silent Myocardial Infarction: A Post Hoc Analysis of a Randomized Controlled Trial |
| title_sort | effect of intensive blood pressure lowering on the risk of incident silent myocardial infarction a post hoc analysis of a randomized controlled trial |
| topic | blood pressure control silent myocardial infarction SPRINT |
| url | https://doi.org/10.1111/anec.70018 |
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