Intensive vs standard systolic blood pressure treatment similarly reduced cardiovascular events in patients with prediabetes (HR 0.69) and normoglycemia (HR 0.83; P-int=0.30).
RCT (n=9,361)
Does intensive systolic blood pressure treatment (<120 mmHg) reduce cardiovascular events in patients with prediabetes compared to standard treatment?
Intensive blood pressure lowering to <120 mmHg provides similar cardiovascular benefits in patients with and without prediabetes.
Effect estimate: HR 0.69 (prediabetes), HR 0.83 (normoglycemia) (95% CI 0.53-0.89 (prediabetes), 0.66-1.03 (normoglycemia))
p-value: p=0.30 for interaction
OBJECTIVE To determine whether the effects of intensive (120 mmHg) compared with standard (140 mmHg) systolic blood pressure (SBP) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial (SPRINT). RESEARCH DESIGN AND METHODS This was a post hoc analysis of SPRINT. SPRINT participants were categorized by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose 100 mg/dL). The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment among those with prediabetes and normoglycemia. RESULTS Among 9,361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (P value for interaction 0.30). For all-cause mortality, the hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (P value for interaction 0.74). Effects of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia (all interaction P 0.05). CONCLUSIONS In SPRINT, the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia.
Bress et al. (Wed,) conducted a rct in High blood pressure with prediabetes or normoglycemia (n=9,361). Intensive systolic blood pressure treatment vs. Standard systolic blood pressure treatment (<140 mmHg) was evaluated on Composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes (HR 0.69 (prediabetes), HR 0.83 (normoglycemia), 95% CI 0.53-0.89 (prediabetes), 0.66-1.03 (normoglycemia), p=0.30 for interaction). Intensive vs standard systolic blood pressure treatment similarly reduced cardiovascular events in patients with prediabetes (HR 0.69) and normoglycemia (HR 0.83; P-int=0.30).