Prediabetes, Malignant Ventricular Hypertrophy and Stroke: The <scp>SPRINT</scp> Trial

AIMS: Prediabetes and left ventricular hypertrophy (LVH) are common risk factors in adults with hypertension. Whether their coexistence, particularly in the presence of subclinical myocardial injury or stress (malignant LVH), confers a heightened stroke risk is unknown. MATERIAL AND METHODS: We analysed 8367 hypertensive adults without diabetes or prior stroke (mean age: 68 ± 9.4 years, 36.8% women, 39.8% with prediabetes) from the Systolic Blood Pressure Intervention Trial (SPRINT). Prediabetes was defined as fasting plasma glucose 100-125 mg/dL. Malignant LVH was defined as electrocardiographic LVH (Cornell voltage product > 2436 mm·ms) with elevated high-sensitivity cardiac troponin I (≥ 6 ng/L in men, ≥ 4 ng/L in women) or N-terminal pro-B-type natriuretic peptide (≥ 125 pg/mL). The primary outcome was incident stroke. Cox proportional hazards models estimated hazard ratios (HRs) across categories of glycemic status and malignant LVH. RESULTS: During a median follow-up of 3.3 years, 116 participants developed stroke. Compared with normoglycemic individuals without malignant LVH, adjusted HRs for stroke were 1.37 (95% CI, 0.88-2.12) for prediabetes alone, 1.94 (95% CI, 1.06-3.53) for malignant LVH alone, and 3.07 (95% CI, 1.66-5.70) for both prediabetes and malignant LVH. The stroke risk was also elevated for prediabetes combined with LVH plus myocardial injury (HR, 3.71; 95% CI, 2.00-6.88) or myocardial stress (HR, 2.84; 95% CI, 1.44-5.58). Results were consistent using alternate LVH definitions. CONCLUSIONS: Among hypertensive adults, the coexistence of prediabetes and malignant LVH substantially increased stroke risk. Integrating metabolic status with cardiac biomarkers may improve cerebrovascular risk stratification.