Effect of additional antihypertensive medications in patients with high-risk hypertension: a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) database

Background: Mixed omega-3 fatty acid preparations have shown inconsistent effects on triglyceride concentrations and cardiovascular (CV) events. Nevertheless, several formulations are widely available as prescription medications. Purpose: To assess the frequency of omega-3 fatty acid use and its association with triglyceride concentrations and CV outcomes in high-risk subjects from the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: SPRINT was a randomized, controlled trial in which non-diabetic individuals aged ≥50 years, at high CV risk, and with a systolic blood pressure (BP) 130-180 mmHg were randomized to intensive (systolic BP target <120mmHg) or standard BP control (systolic BP target 135-139 mmHg). The primary outcome was the composite of acute coronary syndromes, stroke, heart failure, or CV death. Omega-3 fatty acid use was extracted via review of medication records of study participants. We first assessed the association between use of omega-3 fatty acids and triglyceride levels at baseline. We then examined associations between omega-3 fatty acid use and CV events. Finally, we tested whether use of omega-3 fatty acids affected the efficacy of other lipid-lowering agents and of intensive BP control. Results: Of 9361 participants, 680 (7.3%) used omega-3 fatty acids at baseline (632 marine-based, 27 plant-based, and 21 both). Median triglyceride concentrations did not differ between patients on omega-3 fatty acids versus those without (110 (range 25-1701) mg/dl versus 106 (range 23-3340) mg/dl; P=0.08). Median follow-up duration was 3.3 (range 0-4.6) years. Omega-3 fatty acid use was not associated with a reduction in the primary endpoint (adjusted hazard ratio 0.90, 95% confidence interval: 0.65-1.25; P=0.54), any of its individual components, or death from any cause (P≥0.05 for all). Moreover, omega-3 fatty acid use did not modify the effect of any other lipid-lowering agent or of intensive versus standard BP control (P≥0.05 for all). Conclusions: More than 7% of high-risk individuals in SPRINT used omega-3 fatty acid preparations. These agents did not affect CV outcomes. Indiscriminate prescription of omega-3 fatty acids should be discouraged, and only preparations with documented efficacy and safety should be used.

Download Full-text

CLUSTER-RANDOMIZED TRIAL OF A PHYSICIAN/PHARMACIST COLLABORATIVE MODEL TO IMPROVE BLOOD PRESSURE CONTROL: POST-HOC ANALYSIS OF TIME IN THERAPEUTIC RANGE FOR SYSTOLIC BLOOD PRESSURE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02835-7 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1477

Author(s):

Dave L. Dixon ◽

William Baker ◽

Leo Buckley ◽

Teresa M. Salgado ◽

Benjamin Van Tassell ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Pressure Control ◽

Improve Blood Pressure Control ◽

Post Hoc Analysis ◽

Cluster Randomized ◽

Post Hoc ◽

Control Post

Download Full-text

Increased Blood Pressure Variability and the Risk of Probable Dementia or Mild Cognitive Impairment: A Post Hoc Analysis of the SPRINT MIND Trial

Journal of the American Heart Association ◽

10.1161/jaha.121.022206 ◽

2021 ◽

Author(s):

Adam de Havenon ◽

Mohammad Anadani ◽

Shyam Prabhakaran ◽

Ka‐Ho Wong ◽

Shadi Yaghi ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Pressure Control ◽

Post Hoc Analysis ◽

The Mean ◽

Post Hoc

Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow‐up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow‐up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow‐up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively ( P <0.001). In the Cox models, compared with the lowest tertile of BPV, the highest tertile of BPV increased the risk of dementia in both unadjusted (hazard ratio [HR], 2.36; 95% CI, 1.77–3.15) and adjusted (HR, 1.69; 95% CI, 1.25–2.28) models. Conclusions In a post hoc analysis of the SPRINT MIND trial, we found that higher BPV was associated with the development of probable dementia despite excellent blood pressure control. Additional research is needed to understand how to reduce BPV and if its reduction lowers the risk of cognitive impairment and dementia.

Download Full-text

Effect of a Physician/Pharmacist Collaborative Care Model on Time in Target Range for Systolic Blood Pressure: Post Hoc Analysis of the CAPTION Trial

Hypertension ◽

10.1161/hypertensionaha.121.17873 ◽

2021 ◽

Author(s):

Dave L. Dixon ◽

William L. Baker ◽

Leo F. Buckley ◽

Teresa M. Salgado ◽

Benjamin W. Van Tassell ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Collaborative Care ◽

Target Range ◽

Control Group ◽

Care Model ◽

Collaborative Care Model ◽

Post Hoc Analysis ◽

Post Hoc ◽

Time In Target Range

Longer time in target range (TTR) for systolic blood pressure (SBP) is associated with a lower risk of cardiovascular events. Team-based care improves SBP control but its effect on the consistency of SBP control over time is unknown. This post hoc analysis used data from a cluster-randomized trial of a physician/pharmacist collaborative model that randomized medical offices to either a 9- or 24-month pharmacist intervention or control group. TTR for SBP was calculated using linear interpolation and an SBP range of 110 to 130 mm Hg. TTR is reported as median values and group comparisons assessed using the Kruskal-Wallis test. Of the 625 participants enrolled, 524 had 9-month and 366 had 24-month SBP data. Participants were a median 59 years old, 59% female, and 52% minority. After 24 months, the median TTR for SBP was 31.9% and 29.8% for the 9- and 24-month intervention groups, respectively, compared with 19% in the control group ( P =0.0068). This observation persisted in the subgroup of participants with diabetes or chronic kidney disease and minorities. A longer TTR was not associated with an increased risk of adverse drug events. Time to first observed SBP in the target range was shorter in the intervention group compared with control (270 versus 365 days; P =0.0047). A physician/pharmacist collaborative care model achieved longer TTR for SBP compared with control (usual care).

Download Full-text