Abstract
Hypertension is the leading risk factor for premature death and disability. It can be controlled through lifestyle changes and use of antihypertensive medication. This review looks at intensive blood pressure reduction trials in non-diabetic, diabetic, and mixed patients' populations. The primary hypothesis for the Systolic Blood Pressure Intervention Trial (SPRINT) is that treating to a systolic blood pressure target of < 120 mmHg (the intensive intervention) compared to a systolic blood pressure target of < 140 mmHg (the standard intervention) will reduce the primary composite outcome. Lowering systolic blood pressure more rigorously to 120 mmHg instead of the standard 140 mmHg can give substantial benefit according to the SPRINT.SPRINT showed efficacy in older patients above age 75 years. The ACCORD trials did not show efficacy for reducing primary outcomes with intensive therapy in a diabetic population with central obesity not being a significant factor. ACCORD found that intensive blood pressure reduction therapy benefited patients with atrial fibrillation, p-wave indices and left ventricular hypertrophy.
Highlights
High blood pressure affects over one billion people worldwide and is highly prevalent in the adult population of the US [1]
This review looks at intensive blood pressure reduction trials in non-diabetic and diabetic patients to see the benefits of more intensive therapy on major cardiovascular events and secondary outcomes
For the systolic blood pressure intervention trial (SPRINT), the primary hypothesis is that treating to a systolic blood pressure target of < 120 mmHg compared to a systolic blood pressure target of < 140 mmHg will reduce the primary composite outcome of nonfatal myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular disease [24]
Summary
High blood pressure affects over one billion people worldwide and is highly prevalent in the adult population of the US [1]. Data showed that the primary outcome incidence rates were 84.5 per 1,000 person-years in the standard-therapy group vs 73.9 per 1,000 person-years in the intensive-therapy group, a greater reduction with strict control of blood pressure in type 2 diabetes patients that suggests potential benefit in preventing atrial fibrillation and p-wave indices [58]. This result is exceedingly low since the data suggested that almost all of the patients should be treated [94] This is based on the recommendation that diabetes occurring with select additional risk factors (hypertension, albuminuria, cardiovascular disease) should be treated with ACE inhibitors or ARBs. Another study included adults diagnosed with diabetes mellitus from the National Ambulatory Medical Care Survey (NAMCS) during 2007-2010. The American Heart Association and American College of Cardiology maintain a systolic blood pressure goal of < 140 mmHg in those over age 60
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