Intensive Blood Pressure Control Improves Outcomes in Major Cardiovascular Events But Has Risks
Rates of some adverse events are significantly higher for these patients.
Targeting systolic blood pressure to less than 120 mm Hg for patients who do not have diabetes but are at high risk for cardiovascular events results in lower rates of fatal and nonfatal cardiovascular events and death from any cause; however, rates of some adverse events are significantly higher for these patients. These results of a recent study were published online ahead of print in the New England Journal of Medicine.1
Appropriate systolic blood pressure targets to lower risk of cardiovascular morbidity and mortality in persons without diabetes are uncertain.
In this study, researchers compared an intensive treatment targeting systolic blood pressure to less than 120 mm Hg with standard treatment targeting systolic blood pressure to less than 140 mm Hg. Their primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
The study involved 9361 persons with a systolic blood pressure of 130 mm Hg or higher who were at increased risk for cardiovascular events but did not have diabetes. The participants were randomly assigned to intensive treatment or standard treatment.
Mean systolic blood pressure at 1 year was 121.4 mm Hg in the intensive treatment group and 136.2 mm Hg in the standard treatment group.
Researchers stopped the intervention after a median follow-up of 3.26 years due to a significant reduction in primary composite outcome among those who received intensive treatment compared with those who received standard treatment. In addition, all-cause mortality was lower in the intensive-treatment group.
However, rates of serious adverse events were higher among those who received intensive treatment compared with those who received standard treatment. Serious adverse events included hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure. Rates of injurious falls were not higher in the intensive treatment group.
1. SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control [published online ahead of print November 9, 2015]. N Engl J Med. doi:10.1056/NEJMoa1511939.