Increased mortality with intensive control in patients with higher baseline SBP and lower Framingham risk

Abstract

Objective: In the Systolic Blood Pressure Intervention Trial (SPRINT), the relative reduction in primary outcome with intensive blood pressure (BP) control was numerically smallest in the highest baseline SBP tertile. In this post hoc analysis of SPRINT, the goal was to explore whether the effects of intensive BP treatment varied among patients with different baseline SBP and cardiovascular risks.Methods: Patient-level data from 9361 randomized participants in SPRINT were used. Heterogeneity between treatment and patient characteristics were examined stratified by different baseline SBP levels. Cumulative incidences of primary outcome and all-cause death were compared between treatment groups for patients with baseline SBP at least 160 mmHg and lower Framingham risk.Results: For participants with a baseline SBP of at least 160 mmHg, intensive treatment was associated with a higher rate of all-cause death as compared with standard treatment (1.86 vs. 1.62% per year). After adjustment for age and sex, intensive treatment was associated with significantly increased all-cause death compared with standard treatment [hazard ratio (95% CI) for intensive group: 3.12 (1.00-9.69); P ¼ 0.049] in participants with an SBP of at least 160 mmHg and a Framingham risk score of 31.3% or less (average of median and geometric mean). Patient outcomes were otherwise similar regarding age, use of antihypertensive therapy, cardiovascular disease or chronic kidney disease.Conclusion: Among the SPRINT participants with a baseline SBP of at least 160 mmHg and a lower Framingham risk score, targeting an SBP of less than 120mmHg compared with less than 140mmHg resulted in a significantly higher rate of all-cause death.

What Is Wrong with the Blood Pressure Target Recommendation of KDIGO 2021 for Hypertension in Chronic Kidney Disease?

“…Finally, a post hoc analysis of the SPRINT for patients with higher baseline BP at enrolment and without other traditional CV risk factors (which may be the case with younger patients with CKD), lower target BP was associated with increased risk of death [31]. J curve phenomenon-increased CV mortality at very high and low BP is described in the general population as well as in CKD [32].…”

Associations between long-term blood pressure trajectory and all-cause and CVD mortality among old people in China

“…It is worth mentioning that we should be more cautious when generalizing the results from SPRINT. For the elderly whose life expectancy is less than one year, with low Framingham risk score and high baseline SBP (at least 160 mmHg), intensive SBP treatment may not be a good choice ( 14 , 15 ). Some observational studies suggested the cautious application of SBP less than 130 mmHg and observed a U or J shape relationship between BP and all-cause mortality ( 16 , 17 ).…”