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Fewer adults with hypertension met SPRINT (Systolic Blood Pressure Intervention Trial) blood pressure (BP) goals than 2014 Eighth Joint National Committee (JNC) recommendation goals, according to a study published in the Journal of the American College of Cardiology.
Researchers were interested in estimating the proportion of adults with hypertension who would be able to meet BP goals according to SPRINT criteria and the JNC recommendations, and to assess the effects on cardiovascular morbidity and mortality. They gathered data from the Korean National Health and Nutrition Examination Survey of 2008 to 2013 (n=13 346) and the Korean National Health Insurance Service health examinee cohort of 2007 (NHIS; n=67 965).
For the NHIS cohort, the primary clinical outcome was the first occurrence of a major cardiovascular event, defined as the composite of nonfatal myocardial infarction (MI), nonfatal stroke, or death from cardiovascular causes. Individual components of the primary outcome and death from any cause served as the secondary clinical outcomes.
In the final analysis, only 11.9% of individuals met SPRINT BP goals compared with 70.8% who met the 2014 JNC recommendations. Patients who met the SPRINT BP goals had a median systolic BP of 112 mm Hg, whereas the patients who met the 2014 JNC recommendations, but not the SPRINT goals, had a median systolic BP of 132 mm Hg. Patients who did not meet the 2014 JNC recommendation goals had a median systolic BP of 150 mm Hg.
Those individuals who were able to meet stricter BP goals were older, more likely to be female, and had a higher incidence of diabetes, chronic kidney disease, and prevalent cardiovascular disease.
The mean estimate of 10-year risk of cardiovascular disease events was the lowest in individuals who met SPRINT goals (6.15; 95% confidence interval [CI]: 5.64-6.66), intermediate in those who met the 2014 JNC recommendation goals but not SPRINT goals (7.65; CI: 7.34-7.96), and highest in those who did not meet the 2014 JNC recommendation goals (9.39; 95% CI: 8.88-9.90; P<.001).
During the mean duration follow-up of 6.6 ± 1.20 years, 1158 individuals at least 1 major cardiovascular event, 513 had an MI, 664 had a stroke, and 298 died of cardiovascular causes. After multivariable adjustment for potentially confounding clinical covariates, a significant linear trend suggested an association between event risk and weaker BP control for major cardiovascular events (with the intensive group being the reference category, hazard ratios were 1.17 for the less intensive group and 1.62 for the uncontrolled group; P for trend <.001).
“When the potential clinical effects of differences between the JNC 7 and the SPRINT criteria were determined in the NHIS health examinee cohort, there was a significant linear trend toward an increased risk of major cardiovascular events with worse BP control,” researchers wrote. “A linear trend was also significant for cardiovascular death, MI, or stroke.”
When conventional BP criteria (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) were used as an alternative definition of hypertension instead of SPRINT criteria (systolic BP ≥130 mm Hg), there was as significant trend was observed for major cardiovascular events, MI, or stroke, “but the minimal benefit difference between SPRINT and the 2014 JNC recommendations did not occur.”
Researchers pointed that out in the SPRINT trial, the intensive group saw a reduction in cardiovascular disease mortality and heart failure and just a modest, nonsignificant effect on MI or stroke. In the present study, however, the opposite occurred: there was a significant difference in MI or stroke risk, but no difference in cardiovascular or all-cause mortality. “Although the exact reasons remain unclear, this discrepancy might be explained in part by differences in study design, population characteristics, clinical practice pattern, or race or ethnic groups,” they added.
“Further investigations are required to determine the applicability and the potential impact of the results of SPRINT to a less restrictive, general population.”
Reference
Ko MJ, Jo AJ, Park CM, Kim HJ, Kim YJ, Park DW. Level of blood pressure control and cardiovascular events. SPRINT criteria vs the 2014 Hypertension Recommendations. J Am Coll Cardiol. 2016;67(24):2821-2831. doi: 10.1016/j.jacc.2015.03.572.
