Estimated Population Health Benefits of Intensive Systolic Blood Pressure Treatment Among SPRINT-Eligible US Adults

Abstract

Background The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated an intensive (<120 mmHg) versus standard (<140 mmHg) systolic blood pressure (SBP) goal lowered cardiovascular disease (CVD) risk. Estimating the effect of intensive SBP lowering among SPRINT-eligible adults most likely to benefit can guide implementation efforts. Methods We studied SPRINT participants and SPRINT-eligible participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study and National Health and Nutrition Examination Surveys (NHANES). A published algorithm of predicted CVD benefit with intensive SBP treatment was used to categorize participants into low, medium, or high predicted benefit. CVD event rates were estimated with intensive and standard treatment. Results Median age was 67.0 years, 72.0 years, and 64.0 years in SPRINT, SPRINT-eligible REGARDS, and SPRINT-eligible NHANES participants, respectively. The proportion with high predicted benefit was 33.0% in SPRINT, 39.0% in SPRINT-eligible REGARDS, and 23.5% in SPRINT-eligible NHANES. The estimated difference in CVD event rate (standard minus intensive) was 7.0 (95% confidence interval [CI] 3.4-10.7), 8.4 (95%CI 8.2-8.5), and 6.1 (95%CI 5.9-6.3) per 1,000 person-years in SPRINT, SPRINT-eligible REGARDS participants and SPRINT-eligible NHANES participants, respectively (median 3.2-year follow-up). Intensive SBP treatment could prevent 84,300 (95%CI 80,800-87,920) CVD events per year in 14.1 million SPRINT-eligible US adults; 29,400 and 28,600 would be in 7.0 million individuals with medium or high predicted benefit, respectively. Conclusions Most of the population health benefit from intensive SBP goals could be achieved by treating those characterized by a previously published algorithm as having medium or high predicted benefit.

Effectiveness of Hypertension Management Strategies in SPRINT‐Eligible US Adults: A Simulation Study

“…Prior publications have estimated the number of CVD events and deaths that could be prevented each year if SPRINT‐eligible US adults were to receive SPRINT intensive treatment. 4 , 5 Our analysis adds to these by examining longer time horizons of 10 years and remaining lifetime (versus ≤5 years), considering total CVD events (versus first CVD event during SPRINT follow‐up), and examining a return to the usual care process of hypertension management while continuing to target the BP goals from SPRINT (versus treatment according to SPRINT protocol). Additionally, the BP‐CVDPM allowed us to project and compare treatment according to the SPRINT protocol with other hypertension management strategies and BP goals, including modifications to the SPRINT protocol; to our knowledge, this is the first study to address this gap.…”

“… 10 , 16 , 17 , 18 , 19 Of these, 2094 individuals met the SPRINT eligibility criteria (Data S2 ), comparable with other NHANES‐based projections from SPRINT. 4 , 5 To this SPRINT‐eligible NHANES sample, 2 weighting schemes were applied: (1) weighted to create a cohort resembling the baseline characteristics of SPRINT participants (SPRINT‐representative) and (2) weighted to be nationally representative of the population of SPRINT‐eligible US adults using the survey weights from NHANES (Data S2 , Table S1 , and Figure S2 ). Standardized mean differences were used to compare the published baseline characteristics of SPRINT participants with the simulated population under both weighting schemes.…”

“… 2 , 3 There are ≈18.1 million US adults that would meet SPRINT eligibility criteria, and effectively implementing intensive SBP goals could prevent a substantial number of CVD events and deaths. 4 , 5 …”

RNA Injection Every 6 Months to Improve Adherence and Lower Blood Pressure in Patients With Hypertension

“…5 Thus, achieving goal BP is critical to improve outcomes of patients with hypertension, and risk of CVD is significantly reduced by antihypertensive therapy. 6 A 10 mm Hg lower systolic or 5 mm Hg lower diastolic BP results in a 40% reduction in stroke risk and a 30% reduction in ischemic heart disease risk. 7 Control of BP to the therapeutic goal improves outcomes more than treating other chronic conditions, such as dyslipidemia.…”

“…BP elevations above 115/75 mm Hg are associated in a continuous fashion with the risk of fatal stroke, ischemic heart disease, and noncardiac vascular disease, and each increase of 20 mm Hg systolic BP or 10 mm Hg diastolic BP doubles the risk of a fatal cardiovascular event . Thus, achieving goal BP is critical to improve outcomes of patients with hypertension, and risk of CVD is significantly reduced by antihypertensive therapy . A 10 mm Hg lower systolic or 5 mm Hg lower diastolic BP results in a 40% reduction in stroke risk and a 30% reduction in ischemic heart disease risk .…”