Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial.

Pubmed ID: 28793997

Pubmed Central ID: PMC5606306

Journal: Diabetes care

Publication Date: Aug. 9, 2017

Affiliation: Washington Veterans Affairs Medical Center, Washington, DC.

Grants: UL1 TR000445, UL1 TR000005, HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, P30 GM103337, UL1 TR000433, UL1 TR000439, UL1 TR000002, UL1 TR001064, UL1 TR000064, UL1 TR000075, UL1 RR025752, UL1 RR025771, UL1 TR000093, UL1 TR000003, UL1 TR000050, UL1 TR000073, UL1 RR025755, UL1 TR000105, UL1 RR024134, K01 HL133468, UL1 TR002003

Authors: Zhang Y, Beddhu S, Greene T, Evans GW, Cheung AK, Rocco MV, Reboussin DM, Cushman WC, Wiggers A, Papademetriou V, Powell J, Nord J, Rastogi A, Sweeney ME, Zias A, Feinglos MN, Simmons DL, Bress AP, King JB, Kreider KE, Doumas M, Taylor AA, Herring C, Kostis WJ, Roumie CL, Williams JS, Yunis R

Cite As: Bress AP, King JB, Kreider KE, Beddhu S, Simmons DL, Cheung AK, Zhang Y, Doumas M, Nord J, Sweeney ME, Taylor AA, Herring C, Kostis WJ, Powell J, Rastogi A, Roumie CL, Wiggers A, Williams JS, Yunis R, Zias A, Evans GW, Greene T, Rocco MV, Cushman WC, Reboussin DM, Feinglos MN, Papademetriou V, SPRINT Research Group. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017 Aug 9;40(10):1401-8. Epub 2017 Aug 9.

Studies:

Abstract

OBJECTIVE: To determine whether the effects of intensive (&lt;120 mmHg) compared with standard (&lt;140 mmHg) systolic blood pressure (SBP) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial (SPRINT). RESEARCH DESIGN AND METHODS: This was a post hoc analysis of SPRINT. SPRINT participants were categorized by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose &lt;100 mg/dL). The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment among those with prediabetes and normoglycemia. RESULTS: Among 9,361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (<i>P</i> value for interaction 0.30). For all-cause mortality, the hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (<i>P</i> value for interaction 0.74). Effects of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia (all interaction <i>P</i> &gt; 0.05). CONCLUSIONS: In SPRINT, the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia.