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JOURNAL ARTICLE

SP 05-1 SHOULD THE TARGET FOR BLOOD PRESSURE REDUCTION BE LOWER IN ADULTS WITH HYPERTENSION AND A HISTORY OF CARDIOVASCULAR DISEASE

Paul Whelton
Journal of Hypertension 2016, 34 Suppl 1 - ISH 2016 Abstract Book: e378
27754188

BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension.

METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg. Recruitment strategies were designed to enroll a diverse study sample, with representation of major demographic segments of the US population including seniors and patients with prior CVD or CKD. The primary outcome was a composite of first occurrence of myocardial infarction, acute coronary syndrome, stroke, heart failure, or death due to CVD. All-cause mortality was a principal pre-specified secondary outcome.

RESULTS: The study sample encompassed a diverse group of 9,361 volunteers with an average age of 67.9 years and a 10-year Framingham CVD risk of 20.1%. A substantial percentage of those enrolled had a history of CVD (20.1%), CKD (28.5%), or were ≥75 years old (28.2%). The intervention successfully yielded a sustained difference of about 15 mmHg in SBP between the intensive and standard groups. The SPRINT intervention was stopped early after a median of 3.26 years due to beneficial results, with an approximately 30% reduction in the primary outcome and 25% reduction in all-cause mortality in the intensive compared to standard group. Similar results were identified across pre-specified subgroups defined by age, gender, race, presence or absence of CVD, CKD, and baseline tertiles of SBP. Stratification of those ≥75 years by level of frailty and gait speed yielded similar results in all strata studied. As expected, hyponatremia, hypokalemia and hyperkalemia were more common in the intensive group. There was no difference in the rate of serious adverse events (SAEs) between the intensive and standard groups, overall or in those ≥75 years. However, SAEs associated with specific conditions such as hypotension, syncope and acute kidney injury were more common in the intensive group.

CONCLUSIONS: In older adults with hypertension who are at high risk for CVD, targeting a SBP lower than recommended in most current treatment guidelines results in a substantial reduction in CVD events and all-cause mortality compared to standard therapy. The benefits of intensive treatment seem to apply equally to those with CVD, CKD, and age > 75 years.

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