Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

Author(s): Charalambos Vlachopoulos*, Dimitrios Terentes-Printzios, Konstantinos Aznaouridis, Nikolaos Ioakeimidis, Panagiotis Xaplanteris, Georgios Lazaros, Dimitrios Tousoulis.

Journal Name: Current Vascular Pharmacology

Volume 17 , Issue 3 , 2019

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Abstract:

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP).

Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients.

Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome.

Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042).

Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

Keywords: Hypertension, blood pressure, intensive, cardiovascular disease, stroke, acute renal failure.

[1]
Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet 2014; 383: 1899-911.
[2]
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older patients with isolated systolic hypertension. JAMA 1991; 265: 3255-64.
[3]
Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomized trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: 1665.
[4]
Kovell LC, Ahmed HM, Misra S, et al. US hypertension management guidelines: a review of the recent past and recommendations for the future. J Am Heart Assoc 2015; 4: e002315.
[5]
Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373: 2103-16.
[6]
Mancia G, Grassi G. Aggressive blood pressure lowering is dangerous: the J-curve: pro side of the argument. Hypertension 2014; 63: 29-36.
[7]
Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1575-85.
[8]
SPS3 Study Group, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: The SPS3 randomised trial. Lancet 2013; 382: 507-15.
[9]
Reboldi G, Angeli F, de Simone G, et al. Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease. Hypertension 2014; 63: 475-82.
[10]
Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA 2010; 304: 1350-7.
[11]
Shepherd J, Kastelein JJ, Bittner V, et al. Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol 2008; 51: 1448-54.
[12]
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2016; 387: 435-43.
[13]
Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387: 957-67.
[14]
Messerli FH, Panjrath GS. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol 2009; 54: 1827-34.
[15]
Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006; 144: 884-93.
[16]
Sleight P, Redon J, Verdecchia P, et al. Prognostic value of blood pressure in patients with high vascular risk in the ongoing telmisartan alone and in combination with ramipril global endpoint trial study. J Hypertens 2009; 27: 1360-9.
[17]
Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022-31.
[18]
Patel KK, Arnold SV, Chan PS, et al. Personalizing the intensity of blood pressure control: Modeling the heterogeneity of risks and benefits from sprint (Systolic Blood Pressure Intervention Trial). Circ Cardiovasc Qual Outcomes 2017; 10: e003624.
[19]
Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 2016; 315: 2673-82.
[20]
Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol 2017; 28: 2812-23.
[21]
Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 53: 961-73.
[22]
Thomas G, Nally JV, Pohl MA. Interpreting SPRINT: How low should you go? Cleve Clin J Med 2016; 83: 187-95.
[23]
Bress AP, Kramer H, Khatib R, et al. Potential deaths averted and serious adverse events incurred from adoption of the sprint (Systolic Blood Pressure Intervention Trial) intensive blood pressure regimen in the United States: projections from NHANES (National Health and Nutrition Examination Survey). Circulation 2017; 135: 1617-28.
[24]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Hypertension 2018; 71(6): 1269-324.
[25]
Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174: 588-95.
[26]
Filipovský J, Seidlerová J, Kratochvíl Z, Karnosová P, Hronová M, Mayer O Jr. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press 2016; 25: 228-34.
[27]
Tsao J, Gibney K, Wang J, et al. ANA 2017: 142nd Annual meeting of the American neurological association. Abstract M150. Presented October 16, 2017.


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Article Details

VOLUME: 17
ISSUE: 3
Year: 2019
Page: [298 - 306]
Pages: 9
DOI: 10.2174/1570161116666180305160116
Price: $58

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