Effect of Hypertension Duration on the Associations Between Intensive Blood Pressure Control and Cardiac, Vascular, and Kidney Organ Damage

Background: Intensive systolic blood pressure (SBP) treatment could mitigate the increased cardiovascular disease risk associated with long-standing hypertension. Target organ damage serves as a critical intermediate phenotype in hypertension-related sequelae. However, the associations of hypertension duration on the cardiac, vascular, and kidney organ damage improvement of intensive SBP treatment remains to be elucidated. Methods: A total of 8442 STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5~10 years, 10~15 years, and >15 years. Patients were randomly assigned to intensive or standard SBP treatment groups after enrollment. Odds ratios (ORs) for left ventricular hypertrophy, arterial stiffness, and chronic kidney disease were calculated using a logistic regression model, testing for effect modification by hypertension duration. Results: For left ventricular hypertrophy, no evidence showed heterogeneity among groups with different hypertension duration in the treatment effect between intensive versus standard treatment for either new-onset or improvement (both P for interaction >0.05). For arterial stiffness, intensive versus standard SBP treatment showed significantly greater benefits in preventing new-onset arterial stiffness in early-stage (≤5 years: 29.46% versus 36.81%; OR, 0.67 [95% CI, 0.47-0.95]) and long-standing hypertension (>15 years: 30.88% versus 41.23%; OR, 0.62 [95% CI, 0.45-0.84]) compared with the intermediate stage (P for interaction=0.03). For kidney events, no treatment interaction effects or significant associations with hypertension duration were observed (P for interaction >0.05). Conclusions: Intensive SBP treatment showed greater benefits in preventing new-onset arterial stiffness in both early-stage (≤5 years) and long-standing (>15 years) hypertension, whereas no heterogeneity was identified among groups with hypertension for left ventricular hypertrophy and kidney events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.