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Hypertension. 2017 Jan;69(1):42-50. Epub 2016 Nov 14.

Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study.

Author information

1
From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.). draw0003@umn.edu.
2
From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.).

Abstract

The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249.

KEYWORDS:

blood pressure; circadian rhythm; goals; hypertension; stroke

PMID:
27849563
PMCID:
PMC5145774
DOI:
10.1161/HYPERTENSIONAHA.116.08076
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The remaining authors report no conflicts of interest.

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