Abstract
BackgroundUncontrolled blood pressure (BP) increases the risk of major adverse cardiovascular events. In SPRINT an intensive versus standard BP lowering strategy resulted in a lower rate of cardiovascular events and death. Whether BP reduction only or also the choice of anti‐hypertensive drugs is associated with outcomes remains to be elucidated.AimsWe aim to study the association of BP and different anti‐hypertensive drugs with several cardiovascular outcomes.MethodsTime‐updated Cox and mixed‐effects models. The primary outcome was a composite of first myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death.ResultsA total of 9361 patients were included. The anti‐hypertensive agents most frequently used were ACEi/ARBs, with an almost 20% higher prescription rate in the intensive arm (80% vs. 61%), followed by thiazide‐type diuretics (65% vs. 42%), calcium‐channel blockers (57% vs. 39%), and beta‐blockers (52% vs. 26%). Mineralocorticoid receptor antagonists were rarely used (≤7% of the observations). In multivariate analysis, the use of ACEi/ARBs, especially in combination with thiazides, were independently associated with a lower primary outcome event‐rate (HR [95%CI] 0.75 [0.61–0.92], p = .006), whereas a DBP <60 mmHg was independently associated with a higher event‐rate (HR [95%CI] 1.36 [1.07–1.71], p = .011). SBP <120 mmHg was associated with lower rate of cardiovascular and all‐cause death on intensive treatment but not on the standard arm (interaction p < .05 for both).ConclusionsIn SPRINT, an intensive therapy strategy achieving SBP <120 mmHg with a DBP ≥60 mmHg, and using ACEi/ARBs plus thiazides was associated with a lower event‐rate.
Highlights
Hypertension (HT) is the most prevalent cardiovascular disease worldwide.[1]
HT increases the risk of major adverse cardiovascular events (MACE), such as myocardial infarction (MI), stroke, heart failure (HF), chronic kidney disease (CKD), end stage renal disease, and cardiovascular (CV) death.[2]
In this analysis we aim to study the association of blood pressure (BP) and anti-HT medications with the outcomes of the SPRINT trial
Summary
Hypertension (HT) is the most prevalent cardiovascular disease worldwide.[1]. If left uncontrolled, HT increases the risk of major adverse cardiovascular events (MACE), such as myocardial infarction (MI), stroke, heart failure (HF), chronic kidney disease (CKD), end stage renal disease, and cardiovascular (CV) death.[2]. After a median follow-up of 3.3 years, the trial was stopped due to a significantly lower event rate of the primary composite outcome of MI, stroke, incident HF or CV death with intensive treatment in the time-to-first event analysis This effect was mainly driven by a reduction in incident HF and CV death. An intensive treatment strategy was deemed beneficial and with a favorable benefit– risk profile in most patients included in SPRINT.[7] it is not clear whether this observed effect was driven by the lower blood pressure (BP) or by other factors, such as the more frequent use of certain medications (e.g., inhibitors of the renin-angiotensinaldosterone system [RAASi]) in the intensive group that may delay HF onset.[8] In this analysis we aim to study the association of BP and anti-HT medications with the outcomes of the SPRINT trial.
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