Prediabetes, Malignant Left Ventricular Hypertrophy, and Risk of Incident Heart Failure Among Hypertensive Adults

Abstract

Background Prediabetes is common among adults with hypertension, but its contribution to heart failure (HF) risk, particularly in the presence of subclinical myocardial abnormalities, remains uncertain. Objectives The objective of the study was to assess whether prediabetes combined with malignant left ventricular hypertrophy (LVH)—defined as LVH accompanied by subclinical myocardial injury or stress—is associated with increased HF risk in hypertensive adults without diabetes. Methods This prospective cohort analysis included 8,131 hypertensive adults without diabetes or prior HF from the SPRINT (Systolic Blood Pressure Intervention Trial). LVH was defined using the Cornell voltage product. Subclinical myocardial injury was defined as high-sensitivity cardiac troponin I ≥6 ng/L (men) or ≥4 ng/L (women), and subclinical myocardial stress as N-terminal pro–B-type natriuretic peptide ≥125 pg/mL. Cox proportional hazards models estimated adjusted HRs and 95% CIs for HF. Results During a median 3.3-year follow-up, 115 HF events occurred. Compared with normoglycemic adults without malignant LVH, those with both prediabetes and malignant LVH had higher HF risk (adjusted HR: 3.55; 95% CI: 1.98-6.36). Similar patterns were observed for prediabetes with LVH plus myocardial injury (HR: 4.02; 95% CI: 2.21-7.30) or stress (HR: 4.04; 95% CI: 2.22-7.34). Prediabetes alone was not associated with HF (adjusted HR: 1.24; 95% CI: 0.80-1.91). Conclusions Among hypertensive adults, the coexistence of prediabetes and malignant LVH identifies a subgroup at substantially elevated HF risk. Integrating glycemic status, ECG findings, and cardiac biomarkers may enhance HF risk stratification and inform preventive strategies.