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.
N1 - Funding Information:
The Systolic Blood Pressure Intervention Trial is funded with Federal funds from the National Institutes of Health (NIH), including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute on Aging (NIA), and the National Institute of Neurological Disorders and Stroke (NINDS) under Contract Numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and Inter-Agency Agreement Number A-HL-13-002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. We also acknowledge the support from the following Clinical and Transitional Science Awards (CTSAs) funded by National Center For Advancing Translational Sciences (NCATS): CWRU, UL1TR000439; OSU, UL1RR025755; U Penn, UL1RR024134 and UL1TR000003; Boston, UL1RR025771; Stanford, UL1TR000093; Tufts, UL1RR025752, UL1TR000073 and UL1TR001064; University of Illinois, UL1TR000050; University of Pittsburgh, UL1TR000005; UT Southwestern, 9U54TR000017-06; University of Utah, UL1TR000105-05; Vanderbilt University, UL1 TR000445; George Washington University, UL1TR000075; University of CA, Davis, UL1 TR000002; University of Florida, UL1 TR000064; University of Michigan, UL1TR000433; Tulane University, P30GM103337 COBRE Award NIGMS. This work was also supported in part by NIH grants R01AG18915, 1R01HL107257, P30AG021332, and R01AG020583 (Dr Kitzman)
Publisher Copyright:
© 2003 American Heart Association.
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
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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 -