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Abstract: FR-PO1024

Modification of Effect of Intensive Blood Pressure Lowering on Cardiovascular (CV) Outcomes by Baseline Body Mass Index (BMI)

Session Information

Category: Hypertension and CVD

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

Authors

  • Agarwal, Adhish, University of Utah, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Greene, Tom, University of Utah, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

It is unknown whether clinicians should consider body weight when determining the optimal blood pressure (BP) goal for a hypertensive patient. Obesity is independently associated with hypertension (HTN), CV outcomes and mortality; thus may modify the effects of BP control. We conducted a post hoc analysis of the SPRINT to assess whether baseline BMI modifies the effects of intensive (INT) systolic blood pressure (SBP) control.

Methods

SPRINT randomized 9361 high-risk non-diabetic participants with a SBP of 130 mm Hg or higher to either INT SBP target of < 120 mm Hg or standard SBP target of < 140 mm Hg. After excluding participants with a baseline BMI of <18.5 or > 50 Kg/m2 (N= 9191) from SPRINT BioLINCC data, we evaluated the effects of INT SBP control on SPRINT composite outcome (composite of myocardial infarction (MI), acute coronary syndrome (ACS), stroke, acute decompensated heart failure, or CV death) and all-cause death during the mean 4.1 years follow-up in four strata defined by baseline BMI of < 25, 25 to <30, 30 to < 35, and >35 Kg/m2 using Cox proportional hazards models. We also tested the interaction effect between treatment group and baseline BMI as a continuous variable.

Results

The mean age was 67.9 ± 9.4 years, 35.3 % were female, and mean baseline BMI was 29.8 ± 5.4 Kg/m2. There were 1682, 3599, 2413, and 1497 participants respectively in the four baseline BMI strata. The effect of INT SBP control on CV outcome or all-cause mortality did not differ significantly between different baseline BMI levels (P- linear/categorical interactions 0.24/0.31 and 0.12/0.15 respectively).

Conclusion

In the majority of participants in the baseline BMI range of 22 to 35 Kg/m2, INT SBP lowering was beneficial. However, in the extremes of BMI, there was not enough power to draw firm conclusions.

Figure: Forest Plots and Spline Curves with hazard ratios for risk of outcome with INT SBP control