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Abstract: FR-PO1019

Outcomes in Adults with Systolic Blood Pressure Between 130 and 139 mm Hg in ACCORD BP and SPRINT

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Contreras, Gabriel, University of Miami, Miami, Florida, United States
  • Lu, Lingyi, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Tamariz, Leonardo, University of Miami, Miami, Florida, United States
  • Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Papademetriou, Vasilios, Georgetown University, Potomac, Maryland, United States
  • Kostis, John B., Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
  • Pisoni, Roberto, Medical University of South Carolina , Charleston, South Carolina, United States
  • Glasser, Stephen P., UAB, Nicholasville, Kentucky, United States
  • Sweeney, Mary Ellen T., Emory University School of Medicine, Atlanta, Georgia, United States
  • Basile, Jan N., MUSC, Charleston, South Carolina, United States
  • Gren, Lisa H., University of Utah, Salt Lake City, Utah, United States
  • Zamanian, Sara, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States

Group or Team Name

  • The SPRINT Research Group.
Background

Patients with stage 1 systolic hypertension (130-139 mmHg) have increased risk of cardiovascular disease (CVD) events compared to those with normal blood pressure.

Methods

In this post-hoc analysis, we assess the effect of targeting an intensive systolic blood pressure (SBP) goal of less than 120 mmHg compared with standard SBP goal of less than 140 mmHg on the risk of CVD events in adults with stage 1 systolic hypertension enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure (BP) Trial (n=1,901) and the Systolic Blood Pressure Intervention Trial (SPRINT) (n=3,484) using adjusted Cox models. In ACCORD, the primary composite CVD outcome was the first occurrence of myocardial infarction (MI), stroke or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of MI, other acute coronary syndrome, stroke, heart failure or CVD mortality.

Results

In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome (hazard ratio [HR] 0.75, 95% confidence interval [95% CI] 0.57-0.98; 1.78 vs. 2.37 % per year). In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P = 0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome (HR 0.61 [0.40-0.94]; event rates 1.63 vs. 2.56 % per year). In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between SBP goal groups (HR 1.20 [0.76-1.89]; event rates 1.91 vs. 1.60 % per year).

Conclusion

Targeting a SBP goal of less than 120 mmHg significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.

Funding

  • NIDDK Support