SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk

Abstract

The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P =0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage ( P =0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more ( P <0.001 and P <0.01, respectively), and PWV increased less ( P =0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines.

Prognostic Value of Changes in Aortic Stiffness for Cardiovascular Outcomes and Mortality in Resistant Hypertension: a Cohort Study

“…20 More important, a recent randomized controlled trial was performed with 2 parallel groups of hypertensive individuals, one with the intent of normalizing CF-PWV (264 individuals) and the other with traditional antihypertensive management (272 individuals). 38 After a median follow-up of 4 years, the PWV group had lower office and ambulatory SBPs/DBPs and CF-PWV increased less than in the conventional treatment group. However, the study failed in demonstrating differences in CVEs incidence during follow-up because of low statistical power; although the cardiovascular protection of the PWV-guided group appeared more marked, but still nonsignificant, in the subgroup with very high cardiovascular risk.…”

“…If a CF-PWV-guided management strategy would provide better cardiovascular protection than the standard BP-guided management in very high cardiovascular risk hypertensives, this shall be confirmed by future larger interventional studies using serial measurements of CF-PWV. 38,39 ARTICLE INFORMATION…”

Leveraging the potential of machine learning for assessing vascular ageing: state-of-the-art and future research

“… 71 Therefore, there is a need to identify the appropriate population that will benefit most from the use of ML-based methods such as hypertensives or HF patients, 72 as well as the most suitable outcomes such as HF and all-cause mortality, as was clearly demonstrated by the recent ambiguous results of the SPARTE trial. 73 …”

Clinical Applications Measuring Arterial Stiffness: An Expert Consensus for the Application of Cardio-Ankle Vascular Index

“…This proof of concept was just published in the SPARTE (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness) study. 126 Patients with primary hypertension were assigned to a strategy targeting the normalization of PWV measured every 6 months (PWV group, n = 264) vs. a strategy implementing the European Guidelines for Hypertension Treatment (conventional group, n = 272). In the PWV group, renin–angiotensin–system blockers and calcium channel blockers were prescribed at higher dosage ( P = 0.028), PWV increased less ( P = 0.0003) than in the conventional group, and office and ambulatory systolic BP and diastolic BP decreased more ( P < 0.001 and P < 0.01, respectively).…”