Impact of intensive versus standard blood pressure management by tertiles of blood pressure in SPRINT (Systolic Blood Pressure Intervention Trial)

Brian P. Shapiro, Walter T. Ambrosius, Joseph L. Blackshear, William Cushman, Paul K. Whelton, Suzanne Oparil, Srinivasan Beddhu, Jamie P. Dwyer, Lisa H. Gren, William J. Kostis, Michael Lioudis, Roberto Pisoni, Clive Rosendorff, William E. Haley

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/ angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

Original languageEnglish (US)
Pages (from-to)1064-1074
Number of pages11
JournalHypertension
Volume71
Issue number6
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Blood Pressure
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Antihypertensive Agents
Aspirin

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Impact of intensive versus standard blood pressure management by tertiles of blood pressure in SPRINT (Systolic Blood Pressure Intervention Trial). / Shapiro, Brian P.; Ambrosius, Walter T.; Blackshear, Joseph L.; Cushman, William; Whelton, Paul K.; Oparil, Suzanne; Beddhu, Srinivasan; Dwyer, Jamie P.; Gren, Lisa H.; Kostis, William J.; Lioudis, Michael; Pisoni, Roberto; Rosendorff, Clive; Haley, William E.

In: Hypertension, Vol. 71, No. 6, 01.01.2018, p. 1064-1074.

Research output: Contribution to journalArticle

Shapiro, BP, Ambrosius, WT, Blackshear, JL, Cushman, W, Whelton, PK, Oparil, S, Beddhu, S, Dwyer, JP, Gren, LH, Kostis, WJ, Lioudis, M, Pisoni, R, Rosendorff, C & Haley, WE 2018, 'Impact of intensive versus standard blood pressure management by tertiles of blood pressure in SPRINT (Systolic Blood Pressure Intervention Trial)', Hypertension, vol. 71, no. 6, pp. 1064-1074. https://doi.org/10.1161/HYPERTENSIONAHA.117.10646
Shapiro, Brian P. ; Ambrosius, Walter T. ; Blackshear, Joseph L. ; Cushman, William ; Whelton, Paul K. ; Oparil, Suzanne ; Beddhu, Srinivasan ; Dwyer, Jamie P. ; Gren, Lisa H. ; Kostis, William J. ; Lioudis, Michael ; Pisoni, Roberto ; Rosendorff, Clive ; Haley, William E. / Impact of intensive versus standard blood pressure management by tertiles of blood pressure in SPRINT (Systolic Blood Pressure Intervention Trial). In: Hypertension. 2018 ; Vol. 71, No. 6. pp. 1064-1074.
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AU - Shapiro, Brian P.

AU - Ambrosius, Walter T.

AU - Blackshear, Joseph L.

AU - Cushman, William

AU - Whelton, Paul K.

AU - Oparil, Suzanne

AU - Beddhu, Srinivasan

AU - Dwyer, Jamie P.

AU - Gren, Lisa H.

AU - Kostis, William J.

AU - Lioudis, Michael

AU - Pisoni, Roberto

AU - Rosendorff, Clive

AU - Haley, William E.

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Y1 - 2018/1/1

N2 - Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/ angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

AB - Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/ angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP.

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