SPRINT trial: It’s not just the blood pressure!

Abstract

Background The SPRINT trial showed a beneficial effect of systolic blood pressure treatment targets of 120 mmHg on cardiovascular risk compared to targets of 140 mmHg. However, differences in medication use, most importantly diuretics, are suggested as an alternative explanation. This post-hoc analysis aimed to determine whether the reduced event rate can be attributed to changes in systolic blood pressure (ΔSBP) . Methods Analyses were based on all 9361 participants of the SPRINT trial. ΔSBP was defined as the change between baseline and 6-month follow-up systolic blood pressure. Major cardiovascular events were myocardial infarction, other acute coronary syndromes, stroke, heart failure, or cardiovascular death. Cox regression was used to describe the relation between ΔSBP and major cardiovascular events. Analyses were performed separately for patients in the lowest tertile of baseline systolic blood pressure, as the SPRINT trial reported the highest treatment effect in this subgroup. Results The relation between ΔSBP and major cardiovascular events was a hazard ratio per 10 mmHg decrease of 0.93 (95% confidence interval 0.89-0.98). Similar results were found within the lowest tertile of baseline systolic blood pressure: hazard ratio per 10 mmHg decrease 0.91 (95% confidence interval 0.82-1.01). Conclusion Our results show that lowering blood pressure prevents cardiovascular disease. However, not all the positive effects in the SPRINT trial could be explained by ΔSBP. Alternative explanations, such as differences in medication use, should be considered for the positive findings of the SPRINT trial.

Association of Estimated Pulse Wave Velocity With Survival

“…The major strength of our study is the use of data from a well-organized study with close follow-up of patients. Although aspects of this trial have been criticized, 34,35 it has been influential on current recommendations. 12,36 Furthermore, its main findings were corroborated from large meta-analyses of randomized clinical trials showing that intensive BP reduction decreases cardiovascular events.…”

J-shaped relationship between cardiovascular risk and efficacy of intensive blood pressure reduction: A post-hoc analysis of the SPRINT trial

“…Other explanations should be considered, such as dissimilarity in therapy strategies. For instance, higher rates of diuretic use in the intensive treatment group could also account for the positive effects in the SPRINT trial [ 23 ], as low-dose diuretics are beneficial for preventing cardiovascular diseases in heart failure patients [ 24 – 27 ]. It seems further investigations are required to answer the questions regarding a risk-based strategy for treating hypertension.…”

Editor’s Presentation

“…It has been hypothesized that risk stratification can help choose the most favourable systolic blood pressure target for primary prevention of CVD events. In a secondary analysis, based on the data from the SPRINT trial 2 of 4928 subjects, free from diabetes mellitus (DM), stratified according to the Framingham risk score, intensive treatment was found to be very beneficial for patients with medium and high cardiovascular risk score (10-year risk ≥10%) but not in individuals at low risk (10-year risk <10%) and this effect was not influenced by consuming aspirin or statins concomitantly.…”