Prediabetes and left ventricular hypertrophy (LVH) frequently coexist in adults with hypertension, but their combined association with stroke risk remains uncertain. A secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) published in Diabetes, Obesity and Metabolism evaluated the association between prediabetes, malignant LVH, and incident stroke in adults with hypertension.

The analysis included 8,367 adults with hypertension without diabetes or prior stroke at baseline. Mean age was 68 ± 9.4 years, 36.8% were women, and 39.8% had prediabetes, defined as fasting plasma glucose levels of 100-125 mg/dL. Malignant LVH was defined as electrocardiographic LVH with elevated high-sensitivity cardiac troponin I or N-terminal pro-B-type natriuretic peptide levels.

The primary outcome was incident stroke during a median follow-up of 3.3 years. Cox proportional hazards models were used to compare stroke risk across glycemic and malignant LVH categories.

Findings

• During follow-up, 116 participants developed incident stroke.
• Compared with normoglycemic participants without malignant LVH, prediabetes alone was associated with an adjusted hazard ratio (HR) for stroke of 1.37 (95% CI, 0.88-2.12).
• Malignant LVH alone was associated with an adjusted HR of 1.94 (95% CI, 1.06-3.53).
• Participants with both prediabetes and malignant LVH had an adjusted HR for stroke of 3.07 (95% CI, 1.66-5.70).
• Prediabetes combined with LVH plus myocardial injury was associated with an HR of 3.71 (95% CI, 2.00-6.88), while prediabetes combined with LVH plus myocardial stress was associated with an HR of 2.84 (95% CI, 1.44-5.58).
• Associations remained consistent across alternate LVH definitions.

The findings suggested that integrating metabolic status with markers of myocardial injury or stress may help improve cerebrovascular risk stratification in adults with hypertension.