Intensive Versus Standard Blood Pressure Lowering and Days Free of Cardiovascular Events and Serious Adverse Events: a Post Hoc Analysis of Systolic Blood Pressure Intervention Trial

Dae Hyun Kim, Curtis Tatsuoka, Zhengyi Chen, Jackson T. Wright, Michelle C. Odden, Srinivasan Beddhu, Brandon K. Bellows, Adam Bress, Thaddeus Carson, William C. Cushman, Karen C. Johnson, Donald E. Morisky, Henry Punzi, Leonardo Tamariz, Song Yang, Lee Jen Wei

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Communication of the benefits and harms of blood pressure lowering strategy is crucial for shared decision-making. Objectives: To quantify the effect of intensive versus standard systolic blood pressure lowering in terms of the number of event-free days Design: Post hoc analysis of the Systolic Blood Pressure Intervention Trial Participants: A total of 9361 adults 50 years or older without diabetes or stroke who had a systolic blood pressure of 130–180 mmHg and elevated cardiovascular risk Interventions: Intensive (systolic blood pressure goal <120 mmHg) versus standard blood pressure lowering (<140 mmHg) Main Measures: Days free of major adverse cardiovascular events (MACE), serious adverse events (SAE), and monitored adverse events (hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, or acute kidney injury) over a median follow-up of 3.33 years Key Results: The intensive treatment group gained 14.7 more MACE-free days over 4 years (difference, 14.7 [95% confidence interval: 5.1, 24.4] days) than the standard treatment group. The benefit of the intensive treatment varied by cognitive function (normal: difference, 40.7 [13.0, 68.4] days; moderate-to-severe impairment: difference, −15.0 [−56.5, 26.4] days; p-for-interaction=0.009) and self-rated health (excellent: difference, −22.7 [−51.5, 6.1] days; poor: difference, 156.1 [31.1, 281.2] days; p-for-interaction=0.001). The mean overall SAE-free days were not significantly different between the treatments (difference, −14.8 [−35.3, 5.7] days). However, the intensive treatment group had 28.5 fewer monitored adverse event–free days than the standard treatment group (difference, −28.5 [−40.3, −16.7] days), with significant variations by frailty status (non-frail: difference, 38.8 [8.4, 69.2] days; frail: difference, −15.5 [−46.6, 15.7] days) and self-rated health (excellent: difference, −12.9 [−45.5, 19.7] days; poor: difference, 180.6 [72.9, 288.4] days; p-for-interaction <0.001). Conclusions: Over 4 years, intensive systolic blood pressure lowering provides, on average, 14.7 more MACE-free days than standard treatment, without any difference in SAE-free days. Whether this time-based effect summary improves shared decision-making remains to be elucidated.

Original languageEnglish (US)
Pages (from-to)3797-3804
Number of pages8
JournalJournal of General Internal Medicine
Volume37
Issue number15
DOIs
StatePublished - Nov 2022

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint

Dive into the research topics of 'Intensive Versus Standard Blood Pressure Lowering and Days Free of Cardiovascular Events and Serious Adverse Events: a Post Hoc Analysis of Systolic Blood Pressure Intervention Trial'. Together they form a unique fingerprint.

Cite this