Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics

SPRINT Research Group

Research output: Contribution to journalArticle

Abstract

Objectives: This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. Background: SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. Methods: Detailed use of medication data prospectively collected throughout the trial were examined. Results: ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83). Conclusions: No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).

Original languageEnglish (US)
Pages (from-to)1032-1041
Number of pages10
JournalJACC: Heart Failure
Volume7
Issue number12
DOIs
StatePublished - Dec 2019

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Diuretics
Heart Failure
Blood Pressure
Potassium Sparing Diuretics
Confidence Intervals
Research Personnel

Keywords

  • aging
  • diuretics
  • heart failure
  • SPRINT clinical trial
  • systolic hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction : Potential Role of Diuretics. / SPRINT Research Group.

In: JACC: Heart Failure, Vol. 7, No. 12, 12.2019, p. 1032-1041.

Research output: Contribution to journalArticle

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abstract = "Objectives: This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. Background: SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36{\%} fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. Methods: Detailed use of medication data prospectively collected throughout the trial were examined. Results: ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45{\%} to 50{\%} in the standard arm; and from 43{\%} to 63{\%} in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1{\%} (n = 284) of participants in the standard arm and 2.3{\%} (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95{\%} confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6{\%}) and potassium-sparing diuretic agents (2{\%}). Diuretic use was not a predictor of ADHF (HR: 0.96; 95{\%} CI: 0.66 to 1.40; p = 0.83). Conclusions: No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).",
keywords = "aging, diuretics, heart failure, SPRINT clinical trial, systolic hypertension",
author = "{SPRINT Research Group} and Bharathi Upadhya and Lovato, {Laura C.} and Michael Rocco and Lewis, {Cora E.} and Suzanne Oparil and Cushman, {William C.} and Kostis, {John B.} and Rodriguez, {Carlos J.} and Cho, {Monique E.} and Cloud, {Loretta W.} and Anjay Rastogi and Clive Rosendorff and Kitzman, {Dalane W.}",
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T2 - Potential Role of Diuretics

AU - SPRINT Research Group

AU - Upadhya, Bharathi

AU - Lovato, Laura C.

AU - Rocco, Michael

AU - Lewis, Cora E.

AU - Oparil, Suzanne

AU - Cushman, William C.

AU - Kostis, John B.

AU - Rodriguez, Carlos J.

AU - Cho, Monique E.

AU - Cloud, Loretta W.

AU - Rastogi, Anjay

AU - Rosendorff, Clive

AU - Kitzman, Dalane W.

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N2 - Objectives: This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. Background: SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. Methods: Detailed use of medication data prospectively collected throughout the trial were examined. Results: ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83). Conclusions: No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).

AB - Objectives: This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. Background: SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. Methods: Detailed use of medication data prospectively collected throughout the trial were examined. Results: ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83). Conclusions: No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).

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KW - diuretics

KW - heart failure

KW - SPRINT clinical trial

KW - systolic hypertension

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