A randomized trial of intensive versus standard blood-pressure control

Jackson T. Wright, Jeff D. Williamson, Paul K. Whelton, Joni K. Snyder, Kaycee M. Sink, Michael V. Rocco, David M. Reboussin, Mahboob Rahman, Suzanne Oparil, Cora E. Lewis, Paul L. Kimmel, Karen Johnson, David C. Goff, Lawrence J. Fine, Jeffrey A. Cutler, William Cushman, Alfred K. Cheung, Walter T. Ambrosius

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Abstract

BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. RESULTS At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensivetreatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensivetreatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P = 0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensivetreatment group than in the standard-treatment group. CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.

Original languageEnglish (US)
Pages (from-to)2103-2116
Number of pages14
JournalNew England Journal of Medicine
Volume373
Issue number22
DOIs
StatePublished - Nov 26 2015

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Blood Pressure
Therapeutics
Acute Kidney Injury
Cause of Death
Confidence Intervals
Mortality
Syncope
Acute Coronary Syndrome
Hypotension
Electrolytes
Heart Failure
Stroke
Myocardial Infarction
Morbidity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Wright, J. T., Williamson, J. D., Whelton, P. K., Snyder, J. K., Sink, K. M., Rocco, M. V., ... Ambrosius, W. T. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103-2116. https://doi.org/10.1056/NEJMoa1511939

A randomized trial of intensive versus standard blood-pressure control. / Wright, Jackson T.; Williamson, Jeff D.; Whelton, Paul K.; Snyder, Joni K.; Sink, Kaycee M.; Rocco, Michael V.; Reboussin, David M.; Rahman, Mahboob; Oparil, Suzanne; Lewis, Cora E.; Kimmel, Paul L.; Johnson, Karen; Goff, David C.; Fine, Lawrence J.; Cutler, Jeffrey A.; Cushman, William; Cheung, Alfred K.; Ambrosius, Walter T.

In: New England Journal of Medicine, Vol. 373, No. 22, 26.11.2015, p. 2103-2116.

Research output: Contribution to journalArticle

Wright, JT, Williamson, JD, Whelton, PK, Snyder, JK, Sink, KM, Rocco, MV, Reboussin, DM, Rahman, M, Oparil, S, Lewis, CE, Kimmel, PL, Johnson, K, Goff, DC, Fine, LJ, Cutler, JA, Cushman, W, Cheung, AK & Ambrosius, WT 2015, 'A randomized trial of intensive versus standard blood-pressure control', New England Journal of Medicine, vol. 373, no. 22, pp. 2103-2116. https://doi.org/10.1056/NEJMoa1511939
Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV et al. A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine. 2015 Nov 26;373(22):2103-2116. https://doi.org/10.1056/NEJMoa1511939
Wright, Jackson T. ; Williamson, Jeff D. ; Whelton, Paul K. ; Snyder, Joni K. ; Sink, Kaycee M. ; Rocco, Michael V. ; Reboussin, David M. ; Rahman, Mahboob ; Oparil, Suzanne ; Lewis, Cora E. ; Kimmel, Paul L. ; Johnson, Karen ; Goff, David C. ; Fine, Lawrence J. ; Cutler, Jeffrey A. ; Cushman, William ; Cheung, Alfred K. ; Ambrosius, Walter T. / A randomized trial of intensive versus standard blood-pressure control. In: New England Journal of Medicine. 2015 ; Vol. 373, No. 22. pp. 2103-2116.
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AU - Wright, Jackson T.

AU - Williamson, Jeff D.

AU - Whelton, Paul K.

AU - Snyder, Joni K.

AU - Sink, Kaycee M.

AU - Rocco, Michael V.

AU - Reboussin, David M.

AU - Rahman, Mahboob

AU - Oparil, Suzanne

AU - Lewis, Cora E.

AU - Kimmel, Paul L.

AU - Johnson, Karen

AU - Goff, David C.

AU - Fine, Lawrence J.

AU - Cutler, Jeffrey A.

AU - Cushman, William

AU - Cheung, Alfred K.

AU - Ambrosius, Walter T.

PY - 2015/11/26

Y1 - 2015/11/26

N2 - BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. RESULTS At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensivetreatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensivetreatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P = 0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensivetreatment group than in the standard-treatment group. CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.

AB - BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. RESULTS At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensivetreatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensivetreatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P = 0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensivetreatment group than in the standard-treatment group. CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.

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