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Am J Hypertens. 2017 Dec 8;31(1):97-107. doi: 10.1093/ajh/hpx138.

Clinical Outcomes by Race and Ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): A Randomized Clinical Trial.

Author information

1
Frances Payne Bolton School of Nursing, Case Western Reserve University, USA.
2
Wake Forest School of Medicine/Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, USA.
3
School of Medicine, Case Western Reserve University, USA.
4
Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, USA.
5
Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, USA.
6
Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, USA.
7
Stanford University School of Medicine, Division of Nephrology, USA.
8
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA.
9
Department of Medicine, Medical College of Wisconsin, Milwaukee and Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, USA.
10
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, USA.
11
Department of Preventive Medicine, University of Tennessee Health Science Center, USA.
12
Department Social Sciences and Health Policy, School of Medicine, Wake Forest University, USA.
13
Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, USA.
14
Department of Medicine, University of Illinois Chicago, USA.
15
Wake Forest Baptist Health, USA.
16
Department of Medicine, Medical University of South Carolina, USA.
17
Division of General Internal Medicine, Brody School of Medicine, East Carolina University, USA.
18
Memphis Veterans Affairs Medical Center, USA.

Abstract

BACKGROUND:

The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups.

METHODS:

We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death.

RESULTS:

Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57-0.86), 0.71 (0.51-0.98), 0.62 (0.33-1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29-0.81), 0.77 (0.37-1.57), and 0.17 (0.01-1.08). All-cause mortality HRs were 0.61 (0.47-0.80), 0.92 (0.63-1.35), and 1.58 (0.73-3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons.

CONCLUSION:

Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications.

CLINICAL TRIALS REGISTRATION:

Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062.

KEYWORDS:

African Americans; Hispanics; blood pressure; clinical outcomes; clinical trials; hypertension; race and ethnicity

PMID:
28985268
PMCID:
PMC5861531
DOI:
10.1093/ajh/hpx138
[Indexed for MEDLINE]
Free PMC Article

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