Key result
Intensive BP control cuts CV events ~45% in hypertensives under 75 without CVD or CKD.
Why the study?
Does intensive blood pressure treatment (SBP < 120 mm Hg) reduce cardiovascular outcomes and mortality in hypertensive patients over 50 years of age across different age and comorbidity subgroups?
Does intensive blood pressure treatment (SBP < 120 mm Hg) reduce cardiovascular outcomes and mortality in hypertensive patients over 50 years of age across different age and comorbidity subgroups?
Effect estimate: HR 0.55 (95% CI 0.39-0.78)
p-value: p=0.00
The benefits of intensive blood pressure control are heterogeneous, with the greatest impact seen in younger patients without CKD/CVD and older patients with CKD/CVD.
Intensive BP control may benefit younger hypertensives without CVD/CKD; leaves open effects in other subgroups and causality.
The Systolic Blood Pressure Intervention Trial (SPRINT), a large randomized controlled trial funded by the National Institutes of Health, randomized 9361 patients with hypertension over 50 years of age and at least one cardiovascular risk factor to intensive (SBP < 120 mm Hg) or standard (SBP < 140 mm Hg) blood pressure treatment. The trial found a significant reduction in primary cardiovascular and mortality outcomes in the intensive treatment group. We performed an IRB-approved post hoc analysis of the SPRINT trial data, recently made available through the NEJM SPRINT Data Analysis Challenge. Our subgroup analysis stratified subjects by age (≥75 years vs. <75 years) and presence or absence of pre-existing chronic kidney disease (CKD) or cardiovascular disease (CVD). We found that intensive blood pressure control was associated with a significantly lower rate of the primary CVD outcome and all-cause mortality in subjects age <75 years with no prior CVD or CKD and in subjects age ≥75 years with pre-existing CVD or CKD.
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Rostomian et al. (2020) studied Hypertension (n=9,361). Intensive blood pressure treatment vs. Standard blood pressure treatment (target SBP < 140 mm Hg) was evaluated on Cardiovascular events (first occurrence of MI, ACS, stroke, HF, or CVD death) in patients <75 years without CVD or CKD (HR 0.55, 95% CI 0.39-0.78, p=0.00). Intensive blood pressure control significantly reduced the risk of cardiovascular events in hypertensive patients younger than 75 years without baseline CVD or CKD (HR 0.55).
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