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Hypertension. 2018 Jun;71(6):1064-1074. doi: 10.1161/HYPERTENSIONAHA.117.10646. Epub 2018 Apr 30.

Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial).

Author information

1
From the Department of Cardiovascular Diseases (B.P.S., J.L.B.) shapiro.brian@mayo.edu.
2
Mayo Clinic, Jacksonville, FL; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (W.T.A.).
3
From the Department of Cardiovascular Diseases (B.P.S., J.L.B.).
4
Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.).
5
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.).
6
Department of Medicine, University of Alabama at Birmingham (S.O.).
7
Department of Nephrology and Hypertension (S.B.).
8
University of Utah, Salt Lake City; Department of Nephrology, Vanderbilt University, Nashville, TN (J.P.D.).
9
and Department of Family and Preventative Medicine (L.H.G.).
10
Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.).
11
Department of Nephrology and Hypertension, Cleveland Clinic, OH (M.L.).
12
Division of Nephrology, Medical University of South Carolina, Charleston (R.P.).
13
and James J. Peters Veterans Affairs Medical Center, Bronx, NY (C.R.).
14
and Division of Nephrology and Hypertension (W.E.H.).

Abstract

Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

KEYWORDS:

aspirin; blood pressure; follow-up studies; hypertension; risk factors

PMID:
29712745
PMCID:
PMC5945323
[Available on 2019-06-01]
DOI:
10.1161/HYPERTENSIONAHA.117.10646

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