Optimal Systolic Blood Pressure Target in Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from SPRINT and ACCORD.
Pubmed ID: 30142317
Pubmed Central ID: PMC6279479
Journal: The American journal of medicine
Publication Date: 12/01/2018
Affiliation: Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, Gainesville; Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville.
MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Middle Aged, Hypertension, Treatment Outcome, Blood Pressure, Antihypertensive Agents
Grants: UL1 TR000064, UL1 TR001427, K01 HL138172, R01 HL033610, R01 HL132448, UM1 HL087366
Authors: Calhoun DA, Gurka MJ, Smith SM, Gong Y, Pepine CJ, Cooper-DeHoff RM
Cite As: Smith SM, Gurka MJ, Calhoun DA, Gong Y, Pepine CJ, Cooper-DeHoff RM. Optimal Systolic Blood Pressure Target in Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from SPRINT and ACCORD. Am J Med 2018 Dec;131(12):1463-1472.e7. Epub 2018 Aug 22.
- Action to Control Cardiovascular Risk in Diabetes (ACCORD)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
BACKGROUND: Prior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking. METHODS: We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets on adverse outcome risk according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Systolic Blood Pressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (blood pressure ≥130/80 mm Hg while using 3 antihypertensive drugs or use of ≥4 drugs regardless of blood pressure) or non-resistant hypertension (all others). Cox regression was used to assess effects of treatment assignment, resistant hypertension status, their interaction, and other covariates, on first occurrence of 2 outcomes: myocardial infarction, stroke, cardiovascular death ± heart failure, and the same outcomes plus all-cause death, individually. RESULTS: Among 14,094 patients, 2710 (19.2%) had baseline apparent resistant hypertension. In adjusted models, an intensive target reduced risk of both outcomes (myocardial infarction/stroke/cardiovascular death: hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.71-0.93; myocardial infarction/stroke/heart failure/cardiovascular death: HR 0.78; 95% CI, 0.69-0.88) as well as stroke (HR 0.72; 95% CI, 0.55-0.94) and heart failure (HR 0.73; 95% CI, 0.59-0.91). An intensive target also appeared to reduce myocardial infarction, cardiovascular death, and all-cause death risk. Benefits were observed irrespective of baseline resistant hypertension status. CONCLUSIONS: Our findings provide the first evidence to support guidance to treat resistant hypertension to the same blood pressure goal as non-resistant hypertension.