Whether the benefit of intensive blood pressure (BP) control reduces atherosclerotic
cardiovascular disease (ASCVD) risk without increasing risks of serious adverse events
(SAEs) is unknown. We sought to assess differences in incident ASCVD and SAE with
intensive BP control across the spectrum of 10-year ASCVD risk in the Systolic Blood
Pressure Intervention Trial (SPRINT). SPRINT randomized 9,361 participants who were
≥50 years old and ≥1 CVD risk factor to standard or intensive BP control (<120 or 130
to 139 mm Hg). We excluded adults with clinical ASCVD or age ≥80. We included 6,875 participants.
We compared hazard ratios (HR) and risk differences (RD) of incident ASCVD events
or SAEs in all and across quartiles of baseline risk. Median predicted ASCVD risk
was 15.9%. Intensive BP control significantly reduced ASCVD events (HR 0.75, 95% confidence
interval 0.58, 0.97, p = 0.03; RD ˗0.94; ˗1.8, ˗0.1; p = 0.03). There was no difference
in effect across quartiles of ASCVD risk. There was a non-significant increase in
SAE with intensive BP control (HR 1.08, 1.00, 1.17 p = 0.06; RD 2.1, ˗0.1, 4.4, p = 0.03),
and no difference in this effect across quartiles of risk. In SPRINT participants
without baseline clinical ASCVD, the benefit of intensive BP control for primary prevention
of ASCVD may extend to lower risk participants without an increase in SAE. In conclusion,
lower risk adults with stage 1 hypertension meeting SPRINT eligibility may benefit
from initiation of antihypertensives.
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Article info
Publication history
Published online: July 04, 2018
Accepted:
June 25,
2018
Received in revised form:
June 14,
2018
Received:
May 4,
2018
Footnotes
See page 1192 for disclosure information.
Trial registration: ClinicalTrials.gov number NCT01206062
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
