TY - JOUR
T1 - Outcomes in adults with systolic blood pressure between 130 and 139mmHg in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial and Systolic Blood Pressure Intervention Trial
AU - Contreras, Gabriel
AU - Lu, Lingyi
AU - Tamariz, Leonardo
AU - Rocco, Michael V.
AU - Papademetriou, Vasilios
AU - Kostis, John B.
AU - Pisoni, Roberto
AU - Glasser, Stephen P.
AU - Sweeney, Mary E.
AU - Basile, Jan
AU - Gren, Lisa H.
AU - Zamanian, Sara
AU - Cushman, William C.
N1 - Funding Information:
ACCORD BP and/or SPRINT were supported by the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Disease, the National Institute on Aging, the National Institute of Neurological Disorders and Stroke, and the Department of Veterans Affairs. Both studies were approved by responsible institutional review boards for each participating site and each enrolled patient signed informed consent to participate in the trial. The study was approved by the SPRINT research group. Authors analyzed and interpreted the data for this article, with support from the Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC. All aspects of the article writing and revision were initially carried out by authors, with subsequent revisions made according to the SPRINT research group recommendations. We thank Paul K. Whelton, Lawrence Fine, William E. Haley, Suzanne Oparil, Tim Craven, David M. Reboussin, Jeffrey Cutler, Jackson T. Wright Jr, Beth Lewis, members of the SPRINT steering committee and SPRINT investigators. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the US Department of Veterans Affairs, or the US Government.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background:Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events.Methods:Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120mmHg compared with standard SBP goal of less than 140mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n=1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n=3484) that used identical SBP goal interventions.Outcomes:In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality.Results:In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58-0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P=0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40-0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76-1.89); events 1.91 vs. 1.60%/year].Conclusion:Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.
AB - Background:Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events.Methods:Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120mmHg compared with standard SBP goal of less than 140mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n=1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n=3484) that used identical SBP goal interventions.Outcomes:In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality.Results:In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58-0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P=0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40-0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76-1.89); events 1.91 vs. 1.60%/year].Conclusion:Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.
KW - Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial
KW - Systolic Blood Pressure Intervention Trial
KW - cardiovascular disease
KW - diabetes mellitus
KW - stage 1 systolic hypertension
UR - http://www.scopus.com/inward/record.url?scp=85088494667&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088494667&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000002437
DO - 10.1097/HJH.0000000000002437
M3 - Article
C2 - 32371767
AN - SCOPUS:85088494667
VL - 38
SP - 1567
EP - 1577
JO - Journal of Hypertension
JF - Journal of Hypertension
SN - 0263-6352
IS - 8
ER -