Effectiveness of blood pressure-lowering treatment by the levels of baseline Framingham risk score: A post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT).

Pubmed ID: 31670874

Pubmed Central ID: PMC8030550

Journal: Journal of clinical hypertension (Greenwich, Conn.)

Publication Date: Dec. 1, 2019

Link: https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13720

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Case-Control Studies, Risk Factors, Middle Aged, Hypertension, Proportional Hazards Models, Heart Failure, Treatment Outcome, Blood Pressure, Hypotension, Systole, Stroke, Myocardial Infarction, Antihypertensive Agents, Acute Kidney Injury, Death, Acute Coronary Syndrome, Syncope, Bradycardia

Authors: Zhang L, Liao X, Zhou H, Zhang S, Sun X, Zhong X, Zhuang X, Liao L

Cite As: Zhang L, Sun X, Liao L, Zhang S, Zhou H, Zhong X, Zhuang X, Liao X. Effectiveness of blood pressure-lowering treatment by the levels of baseline Framingham risk score: A post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). J Clin Hypertens (Greenwich) 2019 Dec;21(12):1813-1820. Epub 2019 Oct 31.

Studies:

Abstract

This was a post hoc analysis of Systolic Blood Pressure Intervention Trial (SPRINT), aimed to investigate whether intensive blood pressure treatment has differential therapeutic outcomes on patients with different baseline Framingham risk score (FRS). The 9298 SPRINT participants were categorized into low-risk (baseline FRS < 10%), intermediate-risk (FRS = 10%-20%), or high-risk (FRS > 20%) arms. 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. Serious adverse events were defined as hypotension, syncope, and bradycardia. Multiple Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment between these three groups. After a median follow-up time of 3.26 years, the primary outcome hazard ratio (HR) for intensive versus standard treatment was 0.73 (95% CI: 0.61-0.88, P = .0044) in the high-risk arm. And, for all-cause mortality, the hazard ratio with intensive SBP treatment was 1.58 (95% CI: 0.55-1.06), 0.9 (95% CI: 0.26-9.50), and 0.53 (95% CI: 0.34-0.82) in three arms (all P values for interaction > 0.05). Effects of intensive versus standard SBP control on serious adverse events were similar among patients with different FRS. Our results suggested that regardless of the FRS level, the intensive blood pressure control was beneficial.