Abstract: FR-PO747
Does Post-Randomization Diuretics Use Account for the Cardiovascular Benefits of Intensive Systolic Blood Pressure Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT)?
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Bansal, Shweta, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
- Chertow, Glenn, Stanford University School of Medicine, Stanford, California, United States
- Whelton, Paul K., Tulane University Health Sciences Center, New Orleans, Louisiana, United States
- Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
- Shen, Jincheng, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
Background
We examined whether the beneficial effects of intensive systolic blood pressure (SBP)-lowering on major cardiovascular (CV) events in the Systolic Blood Pressure Intervention Trial (SPRINT) could be explained, in part, by increased use of diuretics in the intensive arm.
Methods
The SPRINT evaluated the effects of intensive (<120 mmHg) vs. standard SBP (<140 mmHg) goal on primary outcome (CV composite) and all-cause mortality (ACM) in 9361 participants. In a post-hoc analysis, we examined whether adjustment for post-randomization time-varying diuretic use in Cox regression models attenuated the effects of BP intervention on the primary outcome and ACM. We also performed mediation analyses of post-randomization diuretic use at 6 months to separate the overall effects of the randomized SBP intervention into indirect effects (mediated by diuretic use) and direct effects (mediated through pathways other than diuretic used) on the primary outcome and ACM.
Results
The participants age was 67.9±9.4 years, 36% were women. During the trial, diuretics were used in 46% and 74% of participants in the standard and intensive groups, respectively. There were 726 CV events and 502 deaths over 3.8 years of follow-up. As shown in Fig 1A, intensive SBP goal lowered the risk of primary outcome (HR0.76, 95%CI0.65-0.88) and adjustment for post-randomization time-varying diuretics use did not attenuate the effect (HR0.73, 95%CI0.63-0.85). Formal mediation analyses suggested that the beneficial effects of the SBP intervention on primary outcome were mediated through direct effects and were independent of post-randomization diuretic use (Fig 1B). ACM results were similar.
Conclusion
In this post-hoc analysis of the SPRINT, post-randomization diuretics use did not appear to mediate the beneficial effects of intensive SBP treatment on the CV events and ACM.
Effect of SBP interventions on primary CV composite outcomes by diuretics use
Funding
- NIDDK Support