Abstract

BACKGROUND: Intensive blood pressure (BP) control in patients with low muscle mass on cardiovascular (CV) and cognitive outcomes remains unclear. Therefore, we aim to examine the impact of intensive BP control on CV and cognitive outcomes in patients with low muscle mass. METHODS: Data from the Systolic Blood Pressure Intervention Trial (SPRINT) were utilized to estimate muscle mass. We employed Cox proportional hazard models and generalized linear models to explore how muscle mass status influences the efficacy of intensive BP control on both cardiovascular and cognitive outcomes on relative and absolute scales. Landmark analyses with cutoffs at 3.4 and 2 years assessed primary outcomes. RESULTS: Among 6,367 randomized participants, 469 (7.4%) had baseline low muscle mass. Intensive BP control resulted in a 5.2 events per 1,000 person-years reduction in absolute risk (hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.58-0.89) in patients with normal muscle mass. Conversely, it increased the absolute risk of primary cardiovascular events by 11.1 per 1,000 person-years in those with low muscle mass (HR, 1.72; 95% CI, 0.89-3.34; P = 0.013 for interaction), and led to a significantly higher rate of primary cardiovascular events compared to standard treatment after 3.4 years (P = 0.043). Regardless of the presence of low muscle mass, intensive BP control can reduce both the relative and absolute risks of cognitive outcomes, with all interaction P-values > 0.05. CONCLUSIONS: In persons with low muscle mass, intensive BP control was associated with an increased risk for CV events but not for cognitive decline.