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Influence of baseline systolic blood pressure on the relationship between intensive blood pressure control and cardiovascular outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT)

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Abstract

Objective

To determine whether the effects of intensive (< 120 mmHg) compared with standard (< 140 mmHg) systolic blood pressure (SBP) treatments are different among those with different baseline SBP.

Methods

De-identified SPRINT database was used for this post hoc analysis. SPRINT participants were categorized by baseline SBP status, defined as high-SBP (≥ 140 mmHg) group versus the low-SBP (< 140 mmHg) group. The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Treatment-related adverse events including hypotension, syncope, and bradycardia were also evaluated. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment between these two groups.

Results

Among 9361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 4964 and 4397 had baseline low SBP (< 140 mmHg) and high SBP (≥ 140 mmHg), respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.65 (95% CI 0.50, 0.83) and 0.84 (95% CI 0.66, 1.06) among those in the low-SBP group and high-SBP group, respectively (P value for interaction 0.15). For treatment-related adverse events, the hazard ratio with intensive SBP treatment was 2.03 (95% CI 1.44, 2.85) for the low-SBP group and 1.80 (95% CI 1.32, 2.47) for the high-SBP group (P value for interaction 0.28).

Conclusions

Hypertensive patients with low baseline SBP may benefit from intensive SBP lowering, whereas benefits were inconclusive among those with high baseline SBP.

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Funding

This study was supported by the Natural Science Foundation of Guangdong Province (2016A030310140/20160903) to LXX, and the Natural Science Foundations of China (Grant no. 81600206) to ZXD.

Author information

Author notes

  1. Xiuting Sun and Yue Guo contributed equally to the study.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Xiuting Sun, Yue Guo, Huimin Zhou, Xiangbin Zhong, Shaozhan Zhang, Zhimin Du, Xiaodong Zhuang & Xinxue Liao

  2. Key Laboratory of Assisted Circulation, Ministry of Health, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Xiuting Sun, Yue Guo, Huimin Zhou, Xiangbin Zhong, Shaozhan Zhang, Zhimin Du, Xiaodong Zhuang & Xinxue Liao

  3. Department of Epidemiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China

    Zhiqiang Nie

  4. Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Zhiqiang Nie

  5. Laboratory Medicine Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Jing Cheng

Authors
  1. Xiuting Sun
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Contributions

LXX and ZXX had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: LXX, ZXD, SXT, GY, DZM. Acquisition, analysis, or interpretation of data: NZQ, SXT, ZSZ, ZHM, DZM. Drafting of the manuscript: ZXD, LXX, SXT. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: NZQ, SXT, ZXB. Obtained funding: LXX, ZXD. Administrative, technical, or material support: ZXD.

Corresponding authors

Correspondence to Xiaodong Zhuang or Xinxue Liao.

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Sun, X., Guo, Y., Nie, Z. et al. Influence of baseline systolic blood pressure on the relationship between intensive blood pressure control and cardiovascular outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Res Cardiol 108, 273–281 (2019). https://doi.org/10.1007/s00392-018-1353-9

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  • DOI: https://doi.org/10.1007/s00392-018-1353-9

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