Time to benefit and harm of intensive blood pressure treatment: insights from SPRINT
Key result
Intensive blood pressure treatment is linked to ~1.6% lower absolute MACE but more early adverse events.
- n=9,361
Why the study?
While the magnitude of benefits and harms of intensive blood pressure treatment have been shown, their timing has not been well characterized.
Does intensive blood pressure treatment (<120 mmHg) compared to standard treatment (<140 mmHg) affect the time to benefit and time to harm in SPRINT trial participants?
Population
9361 SPRINT participants
Comparison
Intensive BP treatment (<120 mmHg) vs standard treatment (<140 mmHg)
Design
Post hoc analysis of clinical trial data
Follow-up
4.2 years
Authors
Discussion
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Implication
May inform individualized BP targets with early monitoring; leaves open net benefit confirmation in randomized trials.
Study Design
Type
Observational (n=9,361)
Structured PICO
Does intensive blood pressure treatment (<120 mmHg) compared to standard treatment (<140 mmHg) affect the time to benefit and time to harm in SPRINT trial participants?
P
Population
9,361 SPRINT trial participants analyzed to determine the time to benefit and time to harm of intensive versus standard blood pressure treatment over 4.2 years.
I
Intervention
Intensive blood pressure treatment (target <120 mmHg)
C
Comparator
Standard blood pressure treatment (target <140 mmHg)
O
Outcome
Composite SPRINT MACE outcome (efficacy) and composite of six treatment-related adverse events (safety: hypotension, syncope, bradycardia, injurious falls, electrolyte abnormality, or acute kidney injury)composite
Main Result
Absolute Risk Reduction: 1.6%
Intensive blood pressure control yields cardiovascular benefits starting at 1 year but causes adverse events starting at 3 months, suggesting it may not be appropriate for patients with life expectancy <1 year.
Limitations
- Unclear if results apply to patients who do not meet SPRINT inclusion criteria
- Application of TTB/TTH requires subjective determinations of the relative importance of avoiding MACE vs. avoiding SAEs for each patient
- TTB/TTH determination should be interpreted cautiously in the presence of Kaplan-Meier curves having more than one point of convergence
- Application of TTB/TTH requires subjective determinations of the relative importance of avoiding MACE vs. avoiding SAEs
Cite This Study
Krishnaswami et al. (2020) conducted an observational in Hypertension (n=9,361). Intensive blood pressure treatment vs. Standard treatment (<140 mmHg) was evaluated on Composite SPRINT MACE outcome. Intensive blood pressure treatment (<120 mmHg) reduced MACE beginning at 1 year (absolute benefit 1.6% at 4.2 years), but increased adverse events beginning at 3 months (absolute harm 3.2%).