Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial)
Year: 2018
Type: article
Abstract: Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132–145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction ( P =0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker drugs in the higher tertiles—a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.
Source: Hypertension
Institutions: Mayo Clinic, Mayo Clinic in Florida, Wake Forest University, Veterans Health Administration, Memphis VA Medical Center, Tulane University, University of Alabama at Birmingham, Vanderbilt University, University of Utah, Rutgers, The State University of New Jersey, Cleveland Clinic, Medical University of South Carolina, James J. Peters VA Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Eli Lilly and Company, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Takeda Pharmaceuticals International, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G130883262, G1346455397, G1534123016, G1575401839, G1815451664, Together: Transforming and Translating Discovery to Improve Health, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, G3042542605, G3345260134, Translational Research in Hypertension and Renal Biology, G3759862710, Clinical and Translational Science Institute at Children's National, G467313275, Institutional Clinical and Translational Science Award, G576625284, Tufts Clinical and Translation Science Institute (UL1), The Vanderbilt Institute for Clinical and Translational Research (VICTR), G797306165, Clinical and Translational Science Collaborative of Cleveland, G884570035, G94668252
OpenAlex ID: W2800318836