Abstract P2054: Experiencing the Primary Composite Cardiovascular Outcome is More Strongly Associated With Serious Adverse Events Than Intensive Treatment in the Systolic Blood Pressure Intervention Trial

Hypertension ◽  
2019 ◽  
Vol 74 (Suppl_1) ◽  
Author(s):  
Albert Botchway ◽  
Michael G Buhnerkempe ◽  
Vivek Prakash ◽  
Mohammad Al-Akchar ◽  
Oritsegbubemi Adekola ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
Intensive Treatment ◽  
Cardiovascular Outcome ◽  
Intervention Trial ◽  
Serious Adverse Events

Abstract P179: The Magnitude, And Not Direction, Of Blood Pressure Change Influences The Risk Of Serious Adverse Events In SPRINT

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Michael Buhnerkempe ◽  
Vivek Prakash ◽  
Albert Botchway ◽  
Oritsegbubemi Adekola ◽  
John M Flack
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
Proportional Hazards ◽  
Pressure Change ◽  
Cox Proportional Hazards ◽  
Intensive Treatment ◽  
Atherosclerotic Cardiovascular Disease ◽  
Serious Adverse Events ◽  
Ascvd Risk

Background: The landmark Systolic Blood Pressure Intervention Trial (SPRINT) showed that more intensive systolic blood pressure treatment (SBP < 120 mm Hg) was associated with lower risk for cardiovascular events and mortality but higher risk for serious adverse events (SAEs). However, it is unclear if the magnitude and/or the direction of the BP change determines SAE risk. In this study, we aim to determine how the magnitude and direction of BP change impacts SAE risk. Methods: This is a secondary analysis of 7922 participants in SPRINT. Time-varying Cox proportional hazards models were used to explore the relationship between visit-to-visit BP change and SAE risk. BP change was categorized using five intervals: 1) decreases ≥30 mm Hg, 2) decreases 10-29 mm Hg, 3) increases or decreases <10 mm Hg (reference category), 4) increases 10-29 mm Hg, and 5) increases ≥30 mm Hg. Additional variables adjusted for in the model included: age, gender, race, estimated glomerular filtration rate, treatment group, and baseline atherosclerotic cardiovascular disease (ASCVD) risk. Hypotension was excluded as an SAE to prevent bias in SAE risk in the large BP decrease category. Results: The hazard ratio (HR) for SAEs compared to the minimal BP change category was greatest for BP increases above 30 mm Hg (HR = 1.62, 95% confidence interval [1.30, 2.01]). However, the HR was similar for sharp BP decreases over 30 mm Hg (HR = 1.52 [1.23, 1.87]). Milder BP increases and decreases were associated with lower SAE risk (HR = 1.18 [1.06, 1.32] and HR = 1.10 [0.98, 1.22] for BP changes 10 to 30 mm Hg and -30 to -10 mm Hg, respectively). There were no significant interactions between BP change, intensive treatment, and baseline ASCVD risk. Conclusions: SAE risk was similar for similarly sized increases and decreases in BP between visits, with higher magnitude changes associated with higher SAE risk. When accounting for the magnitude of BP change, no significant effect of intensive treatment or baseline ASCVD risk was found.

scholarly journals Intensive blood pressure lowering in different age categories: insights from the Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 6 (6) ◽  
pp. 356-363 ◽  
Author(s):  
Christina Byrne ◽  
Manan Pareek ◽  
Muthiah Vaduganathan ◽  
Tor Biering-Sørensen ◽  
Arman Qamar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
Primary Efficacy ◽  
Intervention Trial ◽  
Blood Pressure Lowering ◽  
Serious Adverse Events ◽  
Pressure Lowering ◽  
Intensive Blood Pressure

Abstract Aims The 2018 ESC/ESH guidelines for hypertension recommend differential management of patients who are &lt;65, 65–79, and ≥80 years of age. However, it is unclear whether intensive blood pressure lowering is well-tolerated and modifies risk uniformly across the age spectrum. Methods and results SPRINT randomized 9361 high-risk adults without diabetes and age ≥50 years with systolic blood pressure 130–180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. We assessed whether age modified the efficacy and safety of intensive vs. standard blood pressure lowering using Cox proportional-hazards regression and restricted cubic splines. In all, 3805 (41%), 4390 (47%), and 1166 (12%) were &lt;65, 65–79, and ≥80 years. Mean age was similar between the two study groups (intensive group 67.9 ± 9.4 years vs. standard group 67.9 ± 9.5 years; P = 0.94). Median follow-up was 3.3 years. In multivariable models, age was linearly associated with the risk of stroke (P &lt; 0.001) and non-linearly associated with the risk of primary efficacy events, death from cardiovascular causes, death from any cause, heart failure, and serious adverse events (P &lt; 0.001). The safety and efficacy of intensive blood pressure lowering were not modified by age, whether tested continuously or categorically (P &gt; 0.05). Conclusion In SPRINT, the benefits and risks of intensive blood pressure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension. Trial Registration SPRINT (Systolic Blood Pressure Intervention Trial); ClinicalTrials.gov Identifier: NCT01206062, https://clinicaltrials.gov/ct2/show/NCT01206062.

Intensive antihypertensive treatment and serious adverse events in older people

2018 ◽  
Vol 56 (12) ◽  
pp. 143-143
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Older People ◽  
Systolic Blood Pressure ◽  
Antihypertensive Treatment ◽  
Intervention Trial ◽  
Serious Adverse Events ◽  
Treatment Of Hypertension

Review of: Sink KM, et al. Syncope, hypotension and falls in the treatment of hypertension: results from the randomized clinical systolic blood pressure intervention trial. J Am Ger Soc 2018;66:679–86.

scholarly journals Factors Associated With Failure to Achieve the Intensive Blood Pressure Target in the Systolic Blood Pressure Intervention Trial (SPRINT)

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1725-1733
Author(s):  
Katherine M. Wang ◽  
Margaret R. Stedman ◽  
Glenn M. Chertow ◽  
Tara I. Chang
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Risk Reduction ◽  
Estimating Equation ◽  
Cardiovascular Death ◽  
Equation Model ◽  
Blood Pressure Target ◽  
Intervention Trial ◽  
Serious Adverse Events ◽  
Factors Associated

SPRINT (Systolic Blood Pressure Intervention Trial) found that randomization of nondiabetic participants at high cardiovascular risk to an intensive (systolic blood pressure [SBP] <120 mm Hg) versus standard (SBP <140 mm Hg) target resulted in 25% risk reduction in the first cardiovascular composite event (ie, cardiovascular death or nonfatal myocardial infarction, stroke, or hospitalization for heart failure) and a 27% risk reduction in all-cause mortality. In this post hoc analysis, we sought to determine the factors associated with failure to achieve the SBP target in 4678 SPRINT participants randomized to the intensive treatment group. Using a generalized estimating equation model, we assessed variables associated with failure to achieve the intensive SBP target as a repeated outcome collected during serial follow-up visits, including the occurrence of serious adverse events. In the multivariable model adjusted for baseline demographic, clinical, and laboratory variables, older age, higher SBP, underlying chronic kidney disease, higher number of antihypertensives, and moderate cognitive impairment at screening were associated with failure to achieve the intensive SBP target. Occurrence of a serious adverse event during the trial was associated with 20% higher odds of failure to achieve the SBP target. Participants of Hispanic ethnicity had 47% lower odds of failure to achieve the intensive SBP target relative to non-Hispanic Whites. Understanding barriers to achieving intensive SBP targets should allow clinicians to optimize management of hypertension in patients at high risk for cardiovascular disease.

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