Abstract P454: Does Intensive Pulse Pressure control results in lower rates of cardiovascular events? An Analysis of Systolic BP Intervention Trial (SPRINT) database

Abstract

Introduction: A wide pulse pressure (PP) is a marker of increased artery stiffness and high cardiovascular risk. A high PP may reflect already diseased arterial walls, with several adverse cardiac implications of potential prognostic value. Previous studies show that arterial stiffness is itself an independent predictor of the risk of all-cause mortality, cardiovascular mortality, coronary events and stroke in hypertensive subjects. No guidelines exist regarding tight pulse pressure in chronic hypertension population. Method: For the purpose of our study, we examined SPRINT data collected between November 2010 and August 2015. The role of PP and DBP was studied as a qualitative parameter with separation according to the 4 quartiles defined in the studied population. We then combined the results of both PP and DBP in conjunction with preexistence intensive vs. control arm for further analysis. Results: Our secondary analysis of SPRINT data first confirmed NEJM article that intensive SBP control reduced rates of heart failure (HF), CVD death, Death from any cause, and SPRINT primary outcome or death. There was a significant difference in primary outcome in each PP quartile. Higher PP quartiles were more likely to have higher rate of MI, stroke, HF, CVD death, and SPRINT primary outcome or death. There also a significant increase in SPRINT primary outcome and Heart Failure when DBP <70 in the intensive treatment arm. Finally, SPRINT data has confirmed that participants in PP 1 and PP 2 with DBP > 70 have significant lower rate of SPRINT primary outcome and death compared to other group regardless of treatment arm. Conclusion: In the SPRINT database of 9347 participants, we found that higher PP conferred an increased risk for multiple adverse cardiovascular event. Our study is among the largest US studies of PP and adds further support to the prognostic utility of PP. In addition, the SPRINT database offers a contemporary analysis of the relationship between PP and DBP, which is important given that nature pathophysiology of blood pressure. Current study also strengthen the possibility that DBP <70 mm Hg was associated with a higher rate of cardiac events.