Manan Pareek1, Muthiah Vaduganathan1, Tor Biering-Sørensen1, Christina Byrne2, Arman Qamar1, Zaid Almarzooq1, Ambarish Pandey3, Michael Hecht Olsen4, Deepak L Bhatt5. 1. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass. 2. Department of Cardiology, The Heart Centre, Rigshospitalet - Copenhagen University Hospital, Denmark. 3. Department of Cardiology, University of Texas Southwestern Medical Center, Dallas. 4. Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark. 5. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass. Electronic address: dlbhattmd@post.harvard.edu.
Abstract
BACKGROUND: The efficacy and tolerability of intensive blood-pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure). METHODS: SPRINT randomized 9361 high-risk adults without diabetes and who were ≥50 years with systolic blood pressure 130-180 mmHg to intensive or standard antihypertensive treatment. The primary efficacy end point was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety end point was composite serious adverse events. We examined the prognostic implications of baseline pulse pressure and the effects of intensive blood-pressure lowering on clinical outcomes across the spectrum of pulse-pressure values using restricted cubic splines. RESULTS:Mean baseline pulse pressure was similar between the 2 study groups (intensive treatment 61±14 mm Hg vs standard treatment 62±14 mm Hg; P = 0.59). Except stroke, for which the association with pulse pressure was best defined as linear, pulse pressure displayed a nonlinear U-shaped relationship with the risk of all tested clinical end points (P <0.05), though no association remained significant upon multivariable adjustment (P >0.05). The benefit of intensive blood-pressure management on mortality appeared greatest in patients with a pulse pressure ∼60 mm Hg (P = 0.03 for interaction). Pulse pressure did not modify the effect of intensive blood-pressure lowering for other clinical end points (P >0.05 for interaction). CONCLUSION: In a large randomized clinical trial of patients with a high risk of cardiovascular events, risks and benefits of intensive blood-pressure lowering did not appear to be modified by baseline pulse pressure. Selection of appropriate candidates for intensive blood-pressure lowering should not be limited by this parameter.
RCT Entities:
BACKGROUND: The efficacy and tolerability of intensive blood-pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure). METHODS: SPRINT randomized 9361 high-risk adults without diabetes and who were ≥50 years with systolic blood pressure 130-180 mm Hg to intensive or standard antihypertensive treatment. The primary efficacy end point was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety end point was composite serious adverse events. We examined the prognostic implications of baseline pulse pressure and the effects of intensive blood-pressure lowering on clinical outcomes across the spectrum of pulse-pressure values using restricted cubic splines. RESULTS: Mean baseline pulse pressure was similar between the 2 study groups (intensive treatment 61±14 mm Hg vs standard treatment 62±14 mm Hg; P = 0.59). Except stroke, for which the association with pulse pressure was best defined as linear, pulse pressure displayed a nonlinear U-shaped relationship with the risk of all tested clinical end points (P <0.05), though no association remained significant upon multivariable adjustment (P >0.05). The benefit of intensive blood-pressure management on mortality appeared greatest in patients with a pulse pressure ∼60 mm Hg (P = 0.03 for interaction). Pulse pressure did not modify the effect of intensive blood-pressure lowering for other clinical end points (P >0.05 for interaction). CONCLUSION: In a large randomized clinical trial of patients with a high risk of cardiovascular events, risks and benefits of intensive blood-pressure lowering did not appear to be modified by baseline pulse pressure. Selection of appropriate candidates for intensive blood-pressure lowering should not be limited by this parameter.
Authors: Line Reinholdt Pedersen; Anna Meta Dyrvig Kristensen; Søren Sandager Petersen; Muthiah Vaduganathan; Deepak L Bhatt; Jacob Juel; Christina Byrne; Margrét Leósdóttir; Michael H Olsen; Manan Pareek Journal: J Clin Hypertens (Greenwich) Date: 2020-08-19 Impact factor: 3.738