Serum bicarbonate and cardiovascular events in hypertensive adults: results from the Systolic Blood Pressure Intervention Trial
Year: 2019
Type: article
Abstract: BACKGROUND: Low serum bicarbonate level is associated with increased mortality, but its role as a predictor of cardiovascular disease (CVD) is unclear. This study evaluates the association between serum bicarbonate concentration and CVD and whether the effect of intensive blood pressure (BP) lowering on CVD outcomes is modified by serum bicarbonate level. METHODS: The Systolic Blood Pressure Intervention Trial (SPRINT) randomized participants to a systolic BP target <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). The primary CVD outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and CVD death. Cox proportional hazards models adjusted for demographic, clinical and laboratory characteristics were used to evaluate the association of interest in 9334 SPRINT participants (ClinicalTrials.gov: NCT01206062). RESULTS: Over a median follow-up of 3.33 years (interquartile range 2.87-3.87 years), 618 (6.6%) participants experienced a primary CVD outcome. Participants with serum bicarbonate <22 mEq/L had a significantly higher risk of the primary CVD outcome (hazard ratio 1.54; 95% confidence interval 1.11-2.14, P = 0.01), compared with participants with bicarbonate 22-26 mEq/L. The magnitude of the CVD risk reduction with intensive BP lowering was similar across bicarbonate strata (P-value for interaction = 0.97). CONCLUSIONS: In hypertensive individuals, serum bicarbonate level <22 mEq/L was associated with an increased CVD risk. The effect of intensive BP lowering on CVD outcomes was not modified by the serum bicarbonate level.
DOI: 10.1093/ndt/gfz149
Institutions: University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, Case Western Reserve University, Wake Forest University Health Sciences, Wake Forest University, University of Utah, VA Salt Lake City Healthcare System, University of Utah Health Care, University of Colorado Anschutz, University of Colorado Denver, George Washington University, Louis Stokes Cleveland VA Medical Center, Raymond G. Murphy VA Medical Center, New Mexico VA Health Care System, Tufts Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, 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, G1425514332, G1452718737, G1534123016, G1575401839, G1815451664, G2244966566, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, G2866321202, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3042542605, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, G4018866504, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G4564909125, G467313275, G4811516860, G5068655555, G5185313375, G522538789, Institutional Clinical and Translational Science Award, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, Utah Center for Clinical and Translational Science, G6348377030, G709749280, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, G8624175963, G8723760441, G884570035
OpenAlex ID: W2966969167