APPLICABILITY OF THE SPRINT TRIAL IN A REAL WORLD SAMPLE OF HYPERTENSIVE OLDER ADULTS

Abstract

Objective: The SPRINT trial demonstrated the benefits of intensive blood pressure (BP) control in older hypertensive adults, including frailer patients. However, how those results can be applied in the geriatric population remains doubtful, due to the highly selective inclusion criteria and low levels of clinical frailty in the aforementioned series. This study aimed to assess the applicability of SPRINT inclusion criteria in a real world sample of hypertensive older adults and analysed the association between BP and functional decline by SPRINT eligibility. Design and method: We applied SPRINT inclusion and exclusion criteria to a sample of hypertensive patients aged 75 or older, evaluated at the Hypertension and Memory Clinics of the Geriatric Department of Careggi Hospital, Florence. Cox analysis was used to test the association between BP and functional decline (according to Barthel Index) by SPRINT eligibility. Results: Among 123 patients (mean age 81, 59% women), only 39 (32%) complied with the SPRINT inclusion criteria. Frailty prevalence was found to be significantly higher in the ineligible group (46% vs 26%, p = 0.028), along with worse physical performance (reduced walking speed 43% vs 22%, p = 0.027) and disability either in basic (25% vs 5%, p = 0.009) or instrumental activities of daily living (61% vs 33%, p = 0.005). Moreover, they had a higher comorbidity burden (median Charlson Index 5 [4 - 6] vs 4 [3 - 5], p < 0.001), whereas there was no tangible difference between BP values in the two subgroups. At 13 months, ineligible subjects experienced significantly higher incidence of functional decline (48% vs 21%, p = 0.012). In age- and sex-adjusted Cox analysis, ambulatory BP was associated with functional decline only in eligible subjects (24h-systolic BP HR 1.193, 95% CI 1.009 - 1.411). Conclusions: In a real world sample of hypertensive older adults, only one third of subjects complied with the SPRINT inclusion criteria. Higher levels of frailty and disability were observed in ineligible subjects, in whom BP values seem to have a limited prognostic impact.