Impact of Antihypertensive Drug Class on Outcomes in SPRINT

Abstract

Background: The primary objective of this analysis is to assess if greater exposure to any major antihypertensive drug class was associated with reduced primary composite outcome events in SPRINT (Systolic Blood Pressure Intervention Trial). Methods: This is a secondary analysis of the SPRINT trial evaluating whether longitudinal, time varying exposure to any major antihypertensive drug class had any impact on primary outcome events, after adjusting for effects of randomization arm, time varying achieved systolic blood pressure, other drug class exposure, and baseline characteristics. Results: Nine thousand two hundred fifty-two participants were included. After adjustments, exposure of one year or greater to thiazide-type diuretics or renin-angiotensin system blockers was associated with significantly fewer primary events than exposure of less than one year (hazard ratio, 0.78 [95% CI, 0.64–0.94]). There was no significant difference with longer versus shorter exposure to calcium channel blockers. Greater exposure to beta-blockers was associated with an increase in primary events compared with exposure of <1 year (hazard ratio, 1.35 [95% CI, 1.13–1.62]). Furthermore, thiazide-type diuretics were associated with a reduction in heart failure events and renin-angiotensin system blockers with reduced myocardial infarction. Both were associated with less cardiovascular deaths. Conclusions: The SPRINT trial demonstrated a lower target blood pressure led to reductions in adverse cardiovascular events. This analysis suggests greater exposure to thiazide-type diuretics and renin-angiotensin system blockers also contributed to reduced adverse cardiovascular events. Greater exposure to beta-blockers was associated with increased cardiovascular events.

A 10-year review of antihypertensive prescribing practices after stroke and the associated disparities from the Florida Stroke Registry

“…There has been debate about whether the choice of antihypertensive medications matters, but rather only that the blood pressure goal is achieved. There is now new data from the SPRINT trial 26 demonstrating that drug class influences outcomes post stroke with protective effects seen with thiazide type diuretics and angiotensin receptor blockers but a potential for harm with Beta blockers in this setting.…”

Antihypertensive therapy is associated with improved visuospatial, executive, attention, abstraction, memory, and recall scores on the montreal cognitive assessment in geriatric hypertensive patients

“… [36] In a different sub-study of the SPRINT trial, exposures of at least 1 year to thiazide diuretics and RAAS inhibitors were found to reduce adverse events and cardiovascular mortality; on the other hand, the use of beta-blockers was found to increase cardiovascular mortality. [37] Thus, along with consideration of improved cognitive function, other protective as well as risk factors, especially cardiovascular risk factors, should also be kept in mind while prescribing antihypertensive drugs to geriatric patients. Classes including ACEIs, ARBs, and CCBs may be superior to other drug classes, with effects not just limited to lowering blood pressure.…”

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

“…Moreover, a post hoc analysis of the SPRINT study found that patients who received an ARB instead of a calcium channel blocker or beta-blocker for more than one year had a reduction in cardiovascular risk. 37 The advantage of an ARB could be its ability to improve arterial stiffness.…”