BACKGROUND:Cuff blood pressure (BP) is recommended for guiding hypertension management. However, central BP has been proposed as a superior clinical measurement. This study aimed to determine whether controlling hypertension as measured by central BP was beneficial in reducing left ventricular mass index beyond control of standard cuff hypertension.METHODS:This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs.RESULTS:At 24-months, there was a greater reduction in left ventricular mass index (−3.2 [95% CI, −5.0 to −1.3] g/m²; P=0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, −6.16 [−9.60 to −2.72] mm Hg and clinic central systolic BP, −4.96 [−8.06 to −1.86] mm Hg; P≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02–0.31] g/m²) or centrally (24-hour systolic BP, β, 0.16 [0.01–0.32] g/m²).CONCLUSIONS:Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP.REGISTRATION:URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729

中文翻译：

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降低中枢性高血压患者的血压：一项随机临床试验

背景：袖带血压（BP）被推荐用于指导高血压管理。然而，中心血压已被提议作为一种更好的临床测量方法。本研究旨在确定控制中心血压测量的高血压是否有利于降低超出标准袖带高血压控制范围的左心室质量指数。 方法：这项多中心、开放标签、盲终点试验是在接受无并发症高血压治疗的个体中进行的袖带血压受控制（<140/90 mm Hg），但中心血压升高（高于年龄和性别特定正常值≥0.5 SD）。参与者被随机分配接受为期 24 个月的螺内酯 25 毫克/天干预组 (n=148) 或常规护理对照组 (n=153)。主要结果是通过心脏 MRI 测量的左心室质量指数的变化。通过门诊、7 天家庭血压和 24 小时动态血压测量袖带血压和中心血压。 结果：24 个月时，左心室质量指数显着降低（−3.2 [95% CI，−5.0 至 −1.3） ] g/m ²；P =0.001）干预与对照相比。在所有血压测量模式中，袖带和中心血压均降低了相似的幅度（例如，诊所袖带收缩压，-6.16 [-9.60 至 -2.72] mm Hg，诊所中心收缩压，-4.96 [-8.06 至 -1.86] mm汞；P ≥0.48 全部）。二次分析发现，左心室质量指数的变化与血压的变化相关，其影响程度与袖带测量的血压几乎相同（例如，24 小时收缩压，β，0.17 [0.02–0.31] g/m ²）或中枢性（24 小时收缩压，β，0.16 [0.01–0.32] g/m ²）。结论：在患有中心性高血压的个体中，螺内酯对减少左心室质量具有有益作用。二次分析表明，左心室质量的变化与测得的较低标准袖带血压和中心血压同样密切相关。注册：URL：https://www.anzctr.org.au/；唯一标识符：ACTRN12613000053729