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Abstract: PO2090

Associations of Diuretic Use with Cardiovascular Events and All-Cause Mortality in the Systolic BP Intervention Trial (SPRINT)

Session Information

Category: Hypertension and CVD

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

Authors

  • Bansal, Shweta, The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Mediciine, San Antonio, Texas, United States
  • Shen, Jincheng, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Stanford, California, United States
  • Whelton, Paul K., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Cheung, Alfred K., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Group or Team Name

  • SPRINT Consortium
Background

It has been suggested that the beneficial effects of intensive compared to standard treatment of systolic BP (SBP) on the primary outcome of cardiovascular events (CVE) and all-cause mortality (ACM) in the SPRINT were due to increased diuretics use in the intensive arm.

Methods

In a post hoc analysis of SPRINT, we used time-dependent Cox analyses to examine if adjusting for diuretic use during follow-up attenuated the effects of intensive treatment on CVE and ACM. We also examined the interactions of diuretic use with the SBP interventions to assess the presence of effect modification.

Results

Figure1 shows the percentage of intensive and standard treatment participants on diuretics over time. Intensive treatment resulted in lower CVE (HR 0.76, 95%CI 0.65-0.88) and ACM (HR 0.82, 95%CI 0.68-0.97) compared to standard treatment. In Cox regression analyses that controlled for time-dependent diuretic use, the HR for intensive treatment on CVE (HR 0.74, 95%CI 0.64-0.87) and ACM (HR 0.80, 95%CI 0.66-0.96) were similar to main effects, whereas diuretic use was not associated with CVE (HR 0.90, 95%CI 0.76-1.06) or ACM (HR 1.02, 95%CI 0.84-1.25). However, diuretic use was associated with a lower HR for CVE in intensive arm (HR 0.69, 95%CI 0.54-0.90) but not in standard arm (HR 1.07, 95%CI 0.86-1.33), interaction p=0.03. No such interaction was found on ACM.

Conclusion

The main effects of intensive treatment on CVE and ACM were independent of time varying diuretic use. While diuretic use by itself was not associated with a lower HR for CVE in the entire cohort, it associated with lower CVE in intensive but not standard arm. Causal role of diuretic use on CVE needs further study.

Participants on diuretics over time.

Funding

  • NIDDK Support