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Diabetes Obes Metab. 2018 Mar;20(3):629-637. doi: 10.1111/dom.13127. Epub 2017 Nov 9.

Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort.

Author information

1
Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, Ohio.
2
Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
3
Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas.
4
Division of Population Health and Computational Medicine, University of Miami and Geriatric Research and Education Clinical Center, Miami.
5
Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, Ohio.
6
Division of General Internal Medicine, Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Charleston, South Carolina.
7
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida.
8
VA Boston Healthcare System; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
9
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee.
10
Division of Population Health and Computational Medicine, University of Miami and Geriatric Research and Education Clinical Center, Miami, Florida.
11
Division of Primary Care, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin.
12
Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland campus, Cleveland, Ohio.

Abstract

AIMS:

To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity.

METHODS:

We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120 mm Hg (intensive group, N = 4544) or an SBP target of <140 mm Hg (standard group, N = 4553). The median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death.

RESULTS:

Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3 ± 5.6 vs 33.0 ± 5.3 kg/m2 ; P < .01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction = .98). Similarly, there was no evidence of treatment × MetS subgroup interaction for all-cause mortality (adjusted interaction P value = .98). The findings were also similar across race/ethnic subgroups.

CONCLUSIONS:

In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

KEYWORDS:

cardiovascular disease; clinical trial; glucose metabolism; insulin resistance; macrovascular disease; randomized trial

PMID:
29024310
PMCID:
PMC5812782
[Available on 2019-03-01]
DOI:
10.1111/dom.13127
[Indexed for MEDLINE]

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