Targeting an intensive systolic blood pressure <120 mm Hg required a median of 3.0 antihypertensive medication classes at 12 months, compared to 2.0 classes for a standard goal <140 mm Hg (P<0.001).
RCT (n=7,860)
What antihypertensive medication regimens are required to achieve an intensive systolic blood pressure goal of <120 mm Hg compared to a standard goal of <140 mm Hg?
Achieving an intensive SBP goal of <120 mm Hg typically requires a median of 3 antihypertensive medication classes, most commonly combining an ACEi/ARB, thiazide diuretic, and calcium channel blocker.
Absolute Event Rate: 3% vs 2%
p-value: p=<0.001
Background: Describing the antihypertensive medication regimens used in the SPRINT (Systolic Blood Pressure Intervention Trial) would contextualize the standard and intensive systolic blood pressure (SBP) interventions and may inform future implementation efforts to achieve population-wide intensive SBP goals. Methods: We included SPRINT participants with complete medication data at the prerandomization and 12-month visits. Regimens were categorized by antihypertensive medication class. Analyses were stratified by treatment group (standard goal SBP <140 mm Hg versus intensive goal SBP <120 mm Hg). Results: Among 7860 participants (83.7% of 9361 randomized), the median number of classes used at the prerandomization visit was 2.0 and 2.0 in the standard and intensive groups ( P =0.559). At 12-months, the median number of classes used was 3.0 and 2.0 in the intensive and standard groups ( P <0.001). Prerandomization, angiotensin-converting enzyme inhibitor (ACE), or angiotensin-II receptor blocker (ARB) monotherapy was the most common regimen in the intensive and standard groups (12.6% versus 12.2%). At 12-months, ACE/ARB monotherapy was still the most common regimen among standard group participants (14.7%) and was used by 5.3% of intensive group participants. Multidrug regimens used by the intensive and standard participants at 12 months were as follows: an ACE/ARB with thiazide (12.2% and 7.9%); an ACE/ARB with calcium channel blocker (6.2% and 6.8%); an ACE/ARB, thiazide, and calcium channel blocker (11.4% and 4.3%); and an ACE/ARB, thiazide, calcium channel blocker, and beta-blocker (6.5% and 1.2%). Conclusions: SPRINT investigators favored combining ACEs or ARBs, thiazide diuretics, and calcium channel blockers to target SBP <120 mm Hg, compared to ACE/ARB monotherapy to target SBP <140 mm Hg. Registration: URL: https://clinicaltrials.gov ; Unique identifier: NCT01206062.
Derington et al. (Thu,) conducted a rct in Hypertension (n=7,860). Intensive goal SBP <120 mm Hg vs. Standard goal SBP <140 mm Hg was evaluated on Median number of antihypertensive medication classes used at 12 months (p=<0.001). Targeting an intensive systolic blood pressure <120 mm Hg required a median of 3.0 antihypertensive medication classes at 12 months, compared to 2.0 classes for a standard goal <140 mm Hg (P<0.001).