scholarly journals Effects of Intensive Systolic Blood Pressure Control on All-Cause Hospitalizations

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1717-1724
Author(s):  
Michael V. Rocco ◽  
Mary E. Comeau ◽  
Miranda C. Marion ◽  
Barry I. Freedman ◽  
Amret T. Hawfield ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Pressure Control ◽  
Blood Pressure Goal ◽  
Equivalence Testing ◽  
Unique Identifier ◽  
Hospitalization Rates ◽  
Intensive Blood Pressure

Intensive blood pressure control decreases the rate of cardiovascular events by >25% compared with standard blood pressure control. We sought to determine whether the decrease in cardiovascular events seen with intensive blood pressure control is associated with an increased rate of other causes of hospitalization. This is a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial) in 9361 adult participants with hypertension and elevated cardiovascular risk. Participants were randomly assigned to an intensive or standard systolic blood pressure goal (<120 or <140 mm Hg, respectively). The primary outcome was hospitalization rates per 100 person-years for hospitalizations not associated with SPRINT primary events. After excluding hospitalizations linked to SPRINT primary events, there were 4678 participants with a rate of 19.70 hospitalizations per 100 person-years, compared with 4683 participants with a rate of 19.65 ( P =0.37). Equivalence testing shows that these hospitalization rates were statistically equivalent at the P =0.05 level. Of those with hospitalizations, >1 hospitalization was seen in 38.8% of intensive arm participants and 41.9% of standard arm participants ( P =0.08). The mean cumulative count of nonprimary event hospitalizations was comparable between the two arms. The most common causes of hospitalization were cardiovascular (23.6%) followed by injuries, including bone and joint therapeutic procedures (15.7%), infections (12.0%), and nervous systems disorders (10.7%). No categories of hospitalization were statistically more common in the intensive arm compared with the standard arm. Thus, the decrease in cardiovascular events seen with intensive blood pressure control is not associated with an increased rate of other causes of hospitalization. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.

scholarly journals Intensive versus standard blood pressure control and vascular procedures: insights from the Systolic Blood Pressure Intervention Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Byrne ◽  
M Pareek ◽  
D Rujic ◽  
M.L Krogager ◽  
K.H Kragholm ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Aneurysm ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Intervention Trial ◽  
Artery Disease ◽  
Vascular Procedure ◽  
Intensive Blood Pressure

Abstract Background The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure control reduced cardiovascular (CV) morbidity and mortality. Previous studies have shown that control of blood pressure reduces the risk of stroke and is one of the most modifiable risk factors for carotid artery disease. On the other hand, data on effect of blood pressure control on peripheral artery disease are more diverse. In addition, it is unknown whether intensive blood pressure control affects the risk of vascular procedures. Purpose To assess the relationship between intensive blood pressure control and incident vascular procedures. Methods SPRINT was a randomized, controlled trial comprising 9,361 individuals ≥50 years of age at high CV risk but without diabetes who had a systolic BP (SBP) 130–180 mmHg. Patients were randomized to intensive (target SBP &lt;120mmHg) or standard antihypertensive treatment (target SBP &lt;140mmHg). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events. We examined the risk of composite and individual vascular procedures with intensive versus standard blood pressure control. We further examined subgroup heterogeneity using interaction analyses. Results During a median follow-up time of 3.3 years (range 0–5.5 years), a total of 174 (1.9%) composite vascular procedures were recorded. Intensive blood pressure control did not significantly reduce the risk of composite vascular procedures (intensive blood pressure control, 76 (1.6%) versus standard blood pressure control, 98 (2.1%), hazard ratio 0.76, 95% confidence interval, 0.57 to 1.03; P=0.08) (Figure 1). Similarly, the risks of the individual endpoints of carotid angioplasty, carotid endarterectomy, peripheral angioplasty or thrombolysis, lower extremity amputation for ischemia and gangrene, surgical or vascular procedure for abdominal aortic aneurysm, surgical or vascular procedure for thoracic aortic aneurysm, and surgical or vascular procedure for other problems were not significantly affected (P≥0.05 for all). Intensive blood pressure control reduced the risk of peripheral vascular surgery (intensive blood pressure control, 7 (0.2%) versus standard blood pressure control, 21 (0.5%), hazard ratio 0.33, 95% confidence interval, 0.14 to 0.77; P=0.01), though this was based on a small number of events. The safety and efficacy of intensive BP lowering was not modified by chronic kidney disease, age, sex, race, previous cardiovascular disease, or baseline systolic blood pressure tertile (P≥0.05 for all). Conclusions In SPRINT, intensive versus standard blood pressure control did not reduce the risk of composite incident vascular procedures. Figure 1. Vascular procedures Funding Acknowledgement Type of funding source: None

scholarly journals The Impact of Cognitive Function on the Effectiveness and Safety of Intensive Blood Pressure Control for Patients With Hypertension: A post-hoc Analysis of SPRINT

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiafu Yan ◽  
Keyang Zheng ◽  
Aoya Liu ◽  
Wenli Cheng
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Cardiovascular Outcomes ◽  
All Cause Mortality ◽  
The Impact ◽  
Moca Score ◽  
Intensive Blood Pressure

Background: Poor cognitive function can predict poor clinical outcomes. Intensive blood pressure control can reduce the risk of cardiovascular diseases and all-cause mortality. In this study, we assessed whether intensive blood pressure control in older patients can reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality for participants in the Systolic Blood Pressure Intervention Trial (SPRINT) with lower or higher cognitive function based on the Montreal Cognitive Assessment (MoCA) cut-off scores.Methods: The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure &lt;120 mmHg) compared with standard blood pressure control (systolic blood pressure &lt;140 mmHg). We defined MoCA score below education specific 25th percentile as lower cognitive function. And SPRINT participants with a MoCA score below 21 (&lt;12 years of education) or 22 (≥12 years of education) were having lower cognitive function, and all others were having higher cognitive function. The Cox proportional risk regression was used to investigate the association of treatment arms with clinical outcomes and serious adverse effects in different cognitive status. Additional interaction and stratified analyses were performed to evaluate the robustness of the association between treatment arm and stroke in patients with lower cognitive function.Results: Of the participants, 1,873 were having lower cognitive function at baseline. The median follow-up period was 3.26 years. After fully adjusting for age, sex, ethnicity, body mass index, smoking, systolic blood pressure, Framingham 10-year CVD risk score, aspirin use, statin use, previous cardiovascular disease, previous chronic kidney disease and frailty status, intensive blood pressure control increased the risk of stroke [hazard ratio (HR) = 1.93, 95% confidence interval (CI): 1.04–3.60, P = 0.038)] in patients with lower cognitive function. Intensive blood pressure control could not reduce the risk of composite cardiovascular outcomes (HR = 0.81, 95%CI: 0.59–1.12, P = 0.201) and all-cause mortality (HR = 0.93, 95%CI: 0.64–1.35, P = 0.710) in lower cognitive function group. In patients with higher cognitive function, intensive blood pressure control led to significant reduction in the risk of stroke (HR = 0.55, 95%CI: 0.35–0.85, P = 0.008), composite cardiovascular outcomes (HR = 0.68, 95%CI: 0.56–0.83, P &lt; 0.001) and all-cause mortality (HR = 0.62, 95%CI: 0.48–0.80, P &lt; 0.001) in the fully adjusted model. Additionally, after the full adjustment, intensive blood pressure control increased the risk of hypotension and syncope in patients with lower cognitive function. Rates of hypotension, electrolyte abnormality and acute kidney injury were increased in the higher cognitive function patients undergoing intensive blood pressure control.Conclusion: Intensive blood pressure control might not reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality in patients with lower cognitive function.

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