Faculty Opinions recommendation of Potential deaths averted and serious adverse events incurred from adoption of the SPRINT (systolic blood pressure intervention trial) intensive blood pressure regimen in the united states: projections from NHANES (national health and nutrition examination survey).

2017 ◽  
Author(s):  
Wilbert Aronow
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Intervention Trial ◽  
Serious Adverse Events ◽  
Health And Nutrition ◽  
Intensive Blood Pressure

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 <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 <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 < 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 < 0.001). The safety and efficacy of intensive blood pressure lowering were not modified by age, whether tested continuously or categorically (P > 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.

scholarly journals Metal biomarker mixtures and blood pressure in the United States: cross-sectional findings from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Todd M. Everson ◽  
Megan M. Niedzwiecki ◽  
Daniell Toth ◽  
Maria Tellez-Plaza ◽  
Haoran Liu ◽  
...  
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
National Health ◽  
Smoking Status ◽  
The United States ◽  
Metal Exposure ◽  
Nutrition Examination Survey ◽  
Health And Nutrition ◽  
White Adults

Abstract Background The objective of this study was to identify conditional relationships between multiple metal biomarkers that predict systolic and diastolic blood pressure in the non-institutionalized United States adult population below the age of 60. Methods We used inorganic exposure biomarker data and blood pressure data from three cycles (1999–2004) of the National Health and Nutrition Examination Survey (NHANES) to construct regression trees for blood pressure among adults ages 20–60 (adjusted for age, sex, body mass index, race, and smoking status) to identify predictors of systolic (SBP) and diastolic blood pressure (DBP). We also considered relationships among non-Hispanic black, Mexican-American, and white adults separately. Results The following metal exposure biomarkers were conditionally predictive of SBP and/or DBP in the full sample: antimony (Sb), barium (Ba), cadmium (Cd), cesium (Cs), lead (Pb), tungsten (W) and molybdenum (Mo). The highest average SBP (> 120 mmHg) was observed among those with low Sb (≤ 0.21 μg/dL) high Cd (> 0.22 μg/g creatinine) and high Pb (> 2.55 μg/dL) biomarkers. Those with the highest average DBP had high urinary W levels (> 0.10 μg/g creatinine) in combination with either urinary Sb > 0.17 μg/g creatinine or those with urinary Sb ≤ 0.17 μg/g creatinine, but with high blood Pb levels (> 1.35 μg/dL). Predictors differed by ethnicity, with Cd as the main predictor of SBP among non-Hispanic black adults, and Pb not selected by the algorithm as a predictor of SBP among non-Hispanic white adults. Conclusions Combinations of metal biomarkers have different apparent relationships with blood pressure. Additional research in toxicological experimental models and in epidemiological studies is warranted to evaluate the suggested possible toxicological interactions between Sb, Cd, and Pb; and between W, Sb, and Pb; for cardiovascular (e.g., blood pressure) health. We also think future epidemiological research on inorganic exposure sets in relation to health outcomes like blood pressure might benefit from stratification by race and ethnicity.

Risk-Based Intensive Blood Pressure Lowering and Prevention of Heart Failure: A SPRINT Post Hoc Analysis

Hypertension ◽  
2021 ◽  
Author(s):  
Rebecca J. Molsberry ◽  
Leah Rethy ◽  
Michael C. Wang ◽  
Rupal C. Mehta ◽  
Donald M. Lloyd-Jones ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Adverse Events ◽  
Proportional Hazards ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Risk Category ◽  
Serious Adverse Events ◽  
Intensive Blood Pressure

The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated that intensive blood pressure (BP) lowering (target<120 mm Hg) was more effective in preventing heart failure (HF) compared with standard BP goals (target<140 mm Hg). However, intensive BP lowering also led to an increase in serious adverse events. We aimed to identify a subset of the clinical trial population who might derive the greatest benefit from intensive BP lowering for prevention of HF using a previously validated HF risk prediction model. SPRINT participants without prevalent cardiovascular disease were stratified into HF risk tertiles based on predicted HF risk. We performed Kaplan-Meier Survival analysis and multivariable Cox proportional hazards models to test the effect of intensive versus standard BP lowering on incident HF in each tertile of predicted HF risk. A total of 6911 individuals were included and 77 incident HF events occurred over a median follow-up time of 3.3 (interquartile range, 2.9–3.8) years. A reduction in risk of HF was observed among those randomized to intensive BP lowering in each risk tertile but was significant only in the highest HF risk category (risk tertile 1: hazard ratio, 0.86 [95% CI, 0.29–2.56]; risk tertile 2: 0.54 [0.23–1.30]; risk tertile 3: 0.46 [0.24–0.88]). Serious adverse events were frequent in all groups. While the short follow-up may lead to an underestimation of benefit in the lower predicted risk groups, prioritizing intensive BP lowering in those at highest predicted HF risk may help to reduce the high burden of HF in the United States.

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