Does mean systolic blood pressure less than 130 mm Hg ensure high rates of control to <140/<90 mm Hg? A cross-sectional analysis of two cohorts.

Pubmed ID: 40194880

Pubmed Central ID: PMC11977477

Journal: BMJ open

Publication Date: April 7, 2025

MeSH Terms: Humans, Male, Adult, Female, Aged, Middle Aged, Hypertension, Blood Pressure, Cross-Sectional Studies, Antihypertensive Agents, Blood Pressure Determination

Authors: Rodgers A, Moran A, Sutherland SE, Egan B, Martin B, Riesser B, Rakotz M

Cite As: Egan B, Sutherland SE, Martin B, Riesser B, Moran A, Rodgers A, Rakotz M. Does mean systolic blood pressure less than 130 mm Hg ensure high rates of control to <140/<90 mm Hg? A cross-sectional analysis of two cohorts. BMJ Open 2025 Apr 7;15(4):e090440.

Studies:

  • Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data

Abstract

OBJECTIVE: The purpose of this study was to determine how strongly mean systolic blood pressure (mSBP, mm Hg) was related to hypertension control and if an mSBP&lt;130 was required to achieve ≥80% control to &lt;140/&lt;90. DESIGN: mSBP and per cent control to &lt;140/&lt;90 at the last encounter were assessed in a cross-sectional analysis of two cohorts with hypertension: (1) randomised, controlled Systolic blood PRessure Intervention Trial (SPRINT) and (2) real-world American Medical Association's Measure Accurately, Act Rapidly, Partner with patients Hypertension programme. SETTING: SPRINT randomised participants with hypertension to two SBP targets: &lt;140 (standard treatment, SPRINT-S) and &lt;120 (intensive treatment, SPRINT-I). MAP (Measure Accurately, Act Rapidly, Partner with patients) included adults with hypertension at five healthcare systems incentivised by payers to control BP to &lt;140/&lt;90. PARTICIPANTS: SPRINT participants with year 2 data. Patients in MAP (had hypertension, were aged≥18 years, had ≥2 healthcare visits from November 2019 through October 2021 and received care from clinicians (n=544) with ≥24 patients. PRIMARY AND SECONDARY OUTCOME MEASURES: mSBP and control to &lt;140/&lt;90. In MAP, control to &lt;140/&lt;90 was assessed in clinicians grouped by 5 mm Hg increments in the mSBP of their patient panel. RESULTS: In SPRINT-S (n=4303) and SPRINT-I (n=4323), mSBP values at the last visit were 136.7 and 121.7 with BP&lt;140/&lt;90 in 61% and 88% of participants, respectively. In MAP, mSBP at the last visit (n=168 978 patients) was 132.1 with BP&lt;140/&lt;90 in 70% of participants. Among clinicians with participant mSBP of 120 to &lt;125, 88% of their patients were controlled to &lt;140/&lt;90, similar to SPRINT-I. Control fell to 79% of patients, with clinician-level mSBP of 125 to &lt;130, 71%, with mSBP of 130 to &lt;135 and 57%, with mSBP of 135 to &lt;140 (similar to SPRINT-S); mSBP accounted for 80% of variance in clinician-level hypertension control. CONCLUSIONS AND RELEVANCE: mSBP is strongly related to hypertension control. Moreover, mSBP&lt;130 is required to attain control rates to &lt;140/&lt;90 in the range of 80% and higher.