Individual and Joint Effects of Pulse Pressure and Blood Pressure Treatment Intensity on Serious Adverse Events in the SPRINT Trial

Serious adverse events in patients with target-oriented blood pressure management

“…However, serious adverse events have been reported to be insignificantly higher in older than in younger individuals [36]. Other risk factors associated with an increase in adverse effects with antihypertensive treatment have included smoking, statin treatments, elevated creatinine and lipid levels [15], elevated pulse pressure [40] and a high visit-to-visit variability in DBP [41]. Therefore, establishing individualized blood pressure targets, based on patient characteristics, seems reasonable, as suggested by Patel et al [42].…”

When Diastole Lets You Down: Clinical Relevance of a Widened Pulse Pressure

“…In the Systolic Blood Pressure Intervention Trial (SPRINT), in which a target SBP of <120 mm Hg improved CV outcomes compared with a goal of <140 mm Hg, patients with wide PP in the aggressive treatment arm suffered more serious adverse events than did those in the standard treatment arm. 19 These potential harms must be balanced against the potential benefits of treatment. In the Systolic Hypertension in the Elderly Program (SHEP) trial of treatment for isolated systolic hypertension, in which PP is invariably wide, on-treatment DBP < 70 mm Hg was associated with increased CV risk with active treatment but not placebo.…”

Blood Pressure Control and Protection of the Aging Brain

“…Bakris et al addressed some of the controversy regarding newer guidelines including that new stage 1 hypertensive patients might get pharmacological intervention without taking into account the 10-year risk of cardiovascular disease for these people [96]. They also noted that the new recommendations for BP control were the same for the young and elderly population, which could lead to adverse events in people with poor vascular compliance [9,96]. Those with poor vascular compliance had increases in dizziness and mentation when systolic BP was closer to 140 mmHg, a similar finding in the SPRINT study [9,96].…”

“…They also noted that the new recommendations for BP control were the same for the young and elderly population, which could lead to adverse events in people with poor vascular compliance [9,96]. Those with poor vascular compliance had increases in dizziness and mentation when systolic BP was closer to 140 mmHg, a similar finding in the SPRINT study [9,96]. However, the latter study concluded that the new parameters will better benefit individuals that are at high risk for cardiovascular disease [96].…”