Abstract 117: The Impact Of De-escalating Antihypertensive Drugs: A Secondary Analysis Of The Systolic Blood Pressure Intervention Trial (sprint)

Abstract

Introduction: As a chronic disease, patients with hypertension typically receive more antihypertensive drugs. Though this rarely happens, patients may receive fewer antihypertensive drugs (de-escalation) when the SBP is well controlled. SPRINT is a uniquely designed trial to study this impact. In the trial, patients were randomly assigned to two groups where systolic blood pressure (SBP) targets: 1) <120 mmHg (intensive treatment group (IG)); 2) <140 mmHg (standard treatment group (SG)). In both groups, their antihypertensive drugs were continuously adjusted to achieve the SBP targets. Before randomization, physicians may adopt more intensive SBP targets than the above two given patients’ disease severity, and personal preference. This study aims to investigate the impact of de-escalation on cardiovascular outcomes, adverse events, and antihypertensive treatment patterns among hypertensive patients. Methods: By comparing the number of antihypertensives a patient received at the screening visit, and at randomization, we categorized patients into de-escalation (less medications) and normal groups. The primary outcome was a composite of myocardial infarction, acute coronary, heart failure, and cardiovascular death. Secondary outcomes included individual components of the primary outcome and all-cause mortality. Adverse events include hypotension, syncope, and acute kidney injury. Cox proportional-hazards regressions were applied. Results: In the IG, there were 427 and 4,007 patients in the de-escalation and normal groups, respectively. There were 794 and 3,733 patients in these two groups in the SG. The median follow-up time was 3.26 years. In both IG and SG, higher proportions of patients in the de-escalation used thiazide diuretics, ARA, or k-sparing diuretics. In the IG, patients in the de-escalation group were associated with a higher risk of heart failure (HR: 2.66, 95% CI: 1.39-5.09) than the normal group. A similar trend was identified in the de-escalation group for the primary outcome (HR: 1.34, 95% CI: 1.04-1.74). Conclusion: De-escalation is associated with an increased risk of cardiovascular events. It reassures the importance of intensive SBP on patients at high CVD risk and indicates a more intensive SBP target may be needed.