Abstract
Background-Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: Age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg). Methods and Results-ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46-0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase (P<0.001) in cardiovascular death. Conclusions-Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
| Original language | English (US) |
|---|---|
| Article number | e003613 |
| Journal | Circulation: Heart Failure |
| Volume | 10 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2017 |
| Externally published | Yes |
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Keywords
- aging
- clinical trial
- heart failure
- hypertension
- women and minorities
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial. / Upadhya, Bharathi; Rocco, Michael; Lewis, Cora E.; Oparil, Suzanne; Lovato, Laura C.; Cushman, William C.; Bates, Jeffrey T.; Bello, Natalie A.; Aurigemma, Gerard; Fine, Lawrence J.; Johnson, Karen C.; Rodriguez, Carlos J.; Raj, Dominic S.; Rastogi, Anjay; Tamariz, Leonardo; Wiggers, Alan; Kitzman, Dalane W.
In: Circulation: Heart Failure, Vol. 10, No. 4, e003613, 01.04.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial
AU - Upadhya, Bharathi
AU - Rocco, Michael
AU - Lewis, Cora E.
AU - Oparil, Suzanne
AU - Lovato, Laura C.
AU - Cushman, William C.
AU - Bates, Jeffrey T.
AU - Bello, Natalie A.
AU - Aurigemma, Gerard
AU - Fine, Lawrence J.
AU - Johnson, Karen C.
AU - Rodriguez, Carlos J.
AU - Raj, Dominic S.
AU - Rastogi, Anjay
AU - Tamariz, Leonardo
AU - Wiggers, Alan
AU - Kitzman, Dalane W.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background-Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: Age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg). Methods and Results-ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46-0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase (P<0.001) in cardiovascular death. Conclusions-Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
AB - Background-Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: Age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg). Methods and Results-ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46-0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase (P<0.001) in cardiovascular death. Conclusions-Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
KW - aging
KW - clinical trial
KW - heart failure
KW - hypertension
KW - women and minorities
UR - http://www.scopus.com/inward/record.url?scp=85017580658&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017580658&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.116.003613
DO - 10.1161/CIRCHEARTFAILURE.116.003613
M3 - Article
C2 - 28364091
AN - SCOPUS:85017580658
VL - 10
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
SN - 1941-3297
IS - 4
M1 - e003613
ER -