Abstract

BackgroundThis study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China.MethodsA randomized, controlled, open-label trial was conducted in Rongcheng, China. We enrolled 105 hypertensive participants aged over 60 years, and who had no history of stroke or cardiovascular disease. The patients were randomly assigned to one of three systolic-BP target groups: standard: 140 to < 150 mmHg; moderately intensive: 130 to < 140 mmHg; and intensive: < 130 mmHg. The patients were followed for 6 months.DiscussionThe optimal target for systolic blood pressure (SBP) lowering is still uncertain worldwide and such information is critically needed, especially in China. However, in China the rates of awareness, treatment and control are only 46.9%, 40.7%, and 15.3%, respectively. It is challenging to achieve BP control in the real world and it is very important to develop population-specific BP-control protocols that fully consider the population’s characteristics, such as age, sex, socio-economic status, compliance with medication, education level, and lifestyle. This randomized trial showed the feasibility and safety of the titration protocol to achieve desirable SBP targets (< 150, < 140, and < 130 mmHg) in a sample of rural, Chinese hypertensive patients. The three BP target groups had similar baseline characteristics. After 6 months of treatment, the mean SBP measured at an office visit was 137.2 mmHg, 131.1 mmHg, and 124.2 mmHg, respectively, in the three groups. Home BP and central aortic BP measurements were also obtained. At 6 months, home BP measurements (2 h after drug administration) showed a mean SBP of 130.9 mmHg in the standard group, 124.9 mmHg in the moderately intensive group, and 119.7 mmHg in the intensive group. No serious adverse events were recorded over the 6-month study period. Rates of adverse events, including dry cough, palpitations, and arthralgia, were low and showed no significant differences between the three groups. This trial provided real-world experience and laid the foundation for a future, large-scale, BP target study.Trial registrationFeasibility Study of the Intensive Systolic Blood Pressure Control; ClinicalTrials.gov, ID: NCT02817503. Registered retrospectively on 29 June 2016.

Highlights

  • This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China

  • The results of the Systolic Blood Pressure Intervention Trial (SPRINT) [10] in which the investigators targeted a systolic blood pressure (SBP) of < 120 mmHg, as compared to < 140 mmHg, renewed interest on more intensive antihypertensive therapies directed towards a lower BP target among patients at high risk for cardiovascular events but without diabetes

  • BP-control targets Given the lack of consensus on optimal BP targets in the Chinese population, we chose three SBP targets based on American Heart Association previous and new BP guidelines [2, 11, 16] and findings from the two relevant

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Summary

Introduction

This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China. Achieving optimal blood pressure (BP) control is critically important to prevent hypertension-induced end-organ diseases. There is still no consensus as to what is the optimal BP target in the general population for the primary prevention of stroke and cardiovascular disease for people over 60 years of age. The results of the Systolic Blood Pressure Intervention Trial (SPRINT) [10] in which the investigators targeted a SBP of < 120 mmHg, as compared to < 140 mmHg, renewed interest on more intensive antihypertensive therapies directed towards a lower BP target among patients at high risk for cardiovascular events but without diabetes. The optimal target for BP control remains a controversial topic and requires further evidence to weigh the benefits and risks

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