Low blood pressure targets reduce arterial and ventricular mass in diabetics
MedWire News: Achieving low blood pressure levels in diabetic patients is significantly associated with a regression of arterial and ventricular mass, research shows.
"Our findings suggest that there is no threshold of systolic blood pressure below which regression of cardiovascular target organ damage cannot be achieved," state Mary Roman (Weill Cornell Medical College, New York, USA) and colleagues in the journal Hypertension.
Achieving low levels of low-density lipoprotein (LDL) cholesterol, on the other hand, was associated with the regression of arterial, but not ventricular, mass.
Dyslipidemia and hypertension are both risk factors for the development of abnormal carotid artery intima-media thickness (IMT) and mass, which is defined as the cross-sectional area of the artery.
Intervention studies with statin therapy have shown that these LDL cholesterol-lowering medications can reduce the progression of carotid IMT, or even cause regression of atherosclerosis in the artery.
There is strong evidence showing that reducing blood pressure can reduce left ventricular mass. The regression of left ventricular hypertrophy, in turn, improves clinical outcomes, regardless of the reduction in blood pressure levels.
The effect of blood-pressure-lowering medication on carotid IMT is not as well defined.
In the present study, the researchers sought to clarify the relative regression of ventricular and arterial mass attributable to blood-pressure and lipid-lowering therapy.
Included in the analysis were 413 American-Indians with Type 2 diabetes and no pre-existing cardiovascular disease who were treated to varying blood-pressure and LDL-cholesterol targets.
After treatment with the hypertensive and cholesterol-lowering medications, blood pressure, LDL cholesterol, and left ventricular mass were all significantly reduced.
Arterial mass, on the other hand, significantly increased after 36 months of treatment.
In a linear regression analysis, a reduction in arterial mass was significantly associated with reductions in systolic blood pressure, and to a lesser extent, LDL cholesterol.
Left ventricular mass, on the other hand, progressively decreased with achieved reductions in systolic blood pressure, independent of baseline left ventricular mass.
"Although decreases in arterial and LV mass were significant only in the lowest achieved systolic blood pressure group (<115mm Hg), there was a clear trend for lower arterial and LV mass in relation to decreasing values of achieved systolic pressure," state the researchers.
The data showed a graded association between the extent of systolic blood pressure lowering and extent of regression of arterial and LV mass, "with no clear blood pressure threshold below which regression will not occur," they add.
The size of the reduction in arterial mass was significantly related to higher baseline arterial mass, higher baseline systolic blood pressure, and achieved levels of systolic blood pressure and LDL cholesterol.
The magnitude of decrease in left ventricular mass was significantly related to higher baseline LV mass, measures of body size, and achieved levels of systolic blood pressure but not LDL cholesterol.
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