Intensive blood pressure lowering targeting SBP <120 mm Hg showed consistent cardiovascular benefits across subgroups of hypertension duration and baseline SBP (P for interaction=0.399).
RCT (n=11,255)
Does intensive blood pressure lowering targeting SBP below 120 mm Hg reduce major cardiovascular events in hypertensive patients with high cardiovascular risk across different hypertension durations and baseline SBP levels?
Intensive blood pressure control targeting SBP <120 mm Hg provides consistent cardiovascular benefits regardless of hypertension duration or baseline SBP, with the greatest absolute benefit seen in those with long-term uncontrolled BP.
p-value: p=0.399 for interaction
Abstract Background It is uncertain whether long-term exposure to elevated blood pressure (BP) modifies the effects of intensive BP lowering treatment targeting systolic blood pressure (SBP) below 120 mm Hg. Purpose To examine the benefit, harm, and feasibility of targeting SBP below 120 mm Hg compared with below 140 mm Hg across subgroups according to combination of hypertension duration and baseline SBP level. Methods We performed a post-hoc subgroup analysis of the ESPRIT (Effects of intensive Systolic blood Pressure lowering treatment in reducing Risk of vascular evenTs) trial which included hypertensive patients with high cardiovascular risk. Participants were categorized into four subgroups according to hypertension duration and baseline SBP level. We compared major cardiovascular events (myocardial infarction, stroke, hospitalization or emergency room visit for heart failure, or death from cardiovascular causes), all-cause death, safety outcome, and medical resource use (number of antihypertensive medication standard-daily-dose, and number of clinic visit). Results We included 11255 participants (age 64.6±7.1 years; 41.3% female; baseline SBP 146.9±10.6 mm Hg). Among them, 1558 (13.8%) had hypertension10 years and baseline SBP140 mm Hg, 1776 (15.8%) ≥10 years and baseline SBP140 mm Hg, 3440 (30.6%) 10 years and baseline SBP≥140 mm Hg, and 4481 (39.8%) ≥10 years and baseline SBP≥140 mm Hg. The HRs 95% confidence interval (CI) for the major vascular events were 0.92 (0.63–1.34), 0.92 (0.65-1.31), 0.85 (0.66-1.09) and 0.80 (0.66–0.97), respectively (P for interaction =0.399), resulting 200, 143, 83, and 48 patients need to be treated for 3 years to further prevent a major vascular event, respectively. There was no significant between-arm difference in safety outcomes across the four subgroups. Regardless of hypertension duration, participants with uncontrolled BP need a little more excessive antihypertensive medication and clinic visits than those with controlled BP. Conclusions Effects of intensive BP lowering treatment on cardiovascular outcomes were consistent among participants with different duration of hypertension and baseline SBP level. Participants with long-term uncontrolled BP obtained larger absolute benefit from intensive BP control with limited excessive medical resource use.
Peng et al. (2025) conducted an RCT in Hypertension with high cardiovascular risk (n=11,255). Intensive blood pressure lowering (target SBP <120 mm Hg) vs. Standard blood pressure lowering (target SBP <140 mm Hg) was evaluated on Major cardiovascular events (myocardial infarction, stroke, hospitalization or emergency room visit for heart failure, or death from cardiovascular causes) (p=0.399 for interaction). Intensive blood pressure lowering targeting SBP <120 mm Hg showed consistent cardiovascular benefits across subgroups of hypertension duration and baseline SBP (P for interaction=0.399).