Effect of Intensive Blood Pressure Control on Aortic Stiffness in the SPRINT-HEART

Abstract

In a subgroup of 337 participants (mean age 64±9 years; 45% women) from the SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive treatment (target systolic blood pressure <120 mm Hg) versus standard treatment (<140 mm Hg), we examined the effect of intensive blood pressure lowering on indexes of aortic stiffness. Carotid-femoral pulse wave velocity, a validated global measure of aortic stiffness, was measured by echo-guided Doppler at baseline and 18-month follow-up visit. Aortic elastance, distensibility, and compliance were measured by cardiac magnetic resonance imaging. During follow-up, the intensive treatment produced a mean between-group reduction in systolic blood pressure of 12.7 mm Hg (95% CI, 11.1–14.3 mm Hg). During follow-up, intensive treatment significantly attenuated the increase in carotid-femoral pulse wave velocity compared with standard treatment (adjusted follow-up least square mean=9.0 m/s [95% CI, 8.7–9.3] versus 10.0 m/s [9.6–10.3]; P <0.001), an effect that persisted even after adjusting for mean arterial pressure. Intensive treatment also decreased the aortic elastance index (least square mean, 1.38 mm Hg/mL per m 2 [95% CI, 1.34–1.41] versus 1.48 mm Hg/mL per m 2 [95% CI, 1.44–1.51], P =0.002) compared with standard treatment. No significant between-group differences were observed for aortic distensibility and compliance. We conclude that intensive treatment significantly attenuated increases in carotid-femoral pulse wave velocity and aortic elastance index. Attenuation of increases in aortic stiffness may be one of the mechanisms contributing to the benefit of intensive blood pressure treatment observed in SPRINT. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.

Temporal Relationship Between Arterial Stiffness and Systolic Blood Pressure Under Intensive or Standard Control: A Post Hoc Analysis of the STEP Trial

“…In this study, we found that the follow-up baPWV increased by 3.48% in the intensive group and 5.09% in the standard group. Accordingly, the SPRINT-Heart 13 study showed that PWV increased by 8.2% in the standard group (SBP target ≤140 mm Hg) and did not significantly increase in the intensive group (SBP target ≤120 mm Hg). It is not clear whether the effect of SBP lowering treatment on arterial stiffness is the result of SBP reduction or the effect of antihypertensive drugs on arteries.…”

“…Both STEP trial (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) 11 and SPRINT (Systolic Blood Pressure Intervention Trial) 12 found that intensive SBP control significantly reduced the risk of CVD. Furthermore, the SPRINT-Heart trial 13 demonstrated that intensive treatment of SBP significantly attenuated the progression of arterial stiffening in patients with hypertension. However, whether intensive SBP control can alter or counteract the effect of arterial stiffening on SBP is unclear.…”

Influence of baseline arterial stiffness on effects of intensive compared with standard blood pressure control: a post hoc analysis of the STEP trial

“…Given that AS is common in the elderly population [ 28 ], the balance of risks and benefits from intensive SBP treatment should be carefully evaluated according to the AS status of these patients. Previous analyses of the SPRINT trial have shown that intensive treatment significantly attenuates increases in the cfPWV and aortic elastance index, suggesting that attenuating AS progression might be one of the mechanisms underlying the cardiovascular benefit obtained from intensive SBP intervention [ 29 , 30 ]. However, previous researchers did not investigate the influence of the baseline PWV status on the effects of intensive SBP treatment.…”

Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Does Not Reduce Arterial Stiffness in Patients With Type 2 Diabetes After One Year of Follow-Up

“…Arterial stiffness is an early marker of cardiovascular (CV) risk and has been shown to predict CV events independently of traditional risk factors [6,7]. In addition, reduction in arterial stiffness may be associated with improved CV outcome [8,9]. The gold standard for assessing arterial stiffness is carotidfemoral pulse wave velocity (cfPWV) [10].…”