Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes

Abstract

BACKGROUND The previously published results of the Systolic Blood Pressure Intervention Trial showed that among participants with hypertension and an increased cardiovascular risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic blood pressure of less than 120 mm Hg (intensive treatment) than among those who were assigned to a target of less than 140 mm Hg (standard treatment). Whether such intensive treatment affected patient-reported outcomes was uncertain; those results from the trial are reported here. METHODS We randomly assigned 9361 participants with hypertension to a systolic blood-pressure target of less than 120 mm Hg or a target of less than 140 mm Hg. Patient-reported outcome measures included the scores on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Veterans RAND 12-Item Health Survey, the Patient Health Questionnaire 9-item depression scale (PHQ-9), patient-reported satisfaction with their blood-pressure care and blood-pressure medications, and adherence to blood-pressure medications. We compared the scores in the intensive-treatment group with those in the standard-treatment group among all participants and among participants stratified according to physical and cognitive function. RESULTS Participants who received intensive treatment received an average of one additional anti-hypertensive medication, and the systolic blood pressure was 14.8 mm Hg (95% confidence interval, 14.3 to 15.4) lower in the group that received intensive treatment than in the group that received standard treatment. Mean PCS, MCS, and PHQ-9 scores were relatively stable over a median of 3 years of follow-up, with no significant differences between the two treatment groups. No significant differences between the treatment groups were noted when participants were stratified according to baseline measures of physical or cognitive function. Satisfaction with blood-pressure care was high in both treatment groups, and we found no significant difference in adherence to blood-pressure medications. CONCLUSIONS Patient-reported outcomes among participants who received intensive treatment, which targeted a systolic blood pressure of less than 120 mm Hg, were similar to those among participants who received standard treatment, including among participants with decreased physical or cognitive function. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062.)

Intensive versus standard blood pressure treatment improves cardiovascular outcomes without any difference in patient-reported outcomes

“…However, over the follow-up period, there were no statistically significant differences between groups in physical and mental health-related quality of life or depressive symptoms 2. This was unchanged in subgroup analyses, including age and number of coexisting conditions.…”

Impact of Intensive Blood Pressure Therapy on Concern about Falling: Longitudinal Results from the Systolic Blood Pressure Intervention Trial (SPRINT)

“…These results add to the literature demonstrating that lower blood pressure targets can be safe and are unassociated with declines in patient‐reported outcomes. In both SPRINT and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, intensive therapy was not associated with meaningful changes in health‐related quality of life . As with other clinical trials, the lower blood pressure target in SPRINT was unaccompanied by increases in injurious falls …”

Nephro Update Europe 2017

“…A detailed analysis revealed that this was actually not the case, even in patients older than 75 years. In back-to-back papers published this year, Bress et al [10] and Berlowitz et al [11] looked at comparing costeffectiveness and willingness to pay, along with the quality of life for patients on intensive blood pressure-lowering therapy, respectively. The average age of the patients was 75 years of age in the patient satisfaction study, with data taken from the Veterans RAND 12-Item Health Survey [11] .…”

“…In back-to-back papers published this year, Bress et al [10] and Berlowitz et al [11] looked at comparing costeffectiveness and willingness to pay, along with the quality of life for patients on intensive blood pressure-lowering therapy, respectively. The average age of the patients was 75 years of age in the patient satisfaction study, with data taken from the Veterans RAND 12-Item Health Survey [11] . Even with some side effects, such as increased dizziness, there was virtually no difference in quality of life scores for those in standard treatment versus patients in intensive treatment over a period of 48 months.…”