HOPE-3: Hitting Pause on the Blood Pressure Gauge
Changes in hypertension treatment after HOPE-3 and SPRINT.
Current Research in Hypertension
The particulars of “ideal” blood pressure (BP) management have been constantly debated by cardiologists and other hypertension specialists for many years. Central to the debate is the balance between optimal prevention of stroke and coronary and renal disease on the one hand vs minimization of symptomatic side effects and serious adverse events on the other.
In November 2015, for example, results from the SPRINT trial clearly seemed to support lower BP goals as more aggressive treatment yielded better overall outcomes for the study population.1
Just this past month, the HOPE-3 (Heart Outcomes Prevention Evaluation) trial2 took a somewhat different turn. HOPE-3 provided the luxury of solid clinical trial data in treatment of both hypertension and lipidology in the same study by use of an uncommon 2-by-2 factorial trial design. That is, there were 3 intervention arms, treating BP, or cholesterol, or both, compared with a double-placebo arm. The primary endpoint was cardiovascular disease (CVD) and the subjects were at “intermediate” CVD risk, without a prior event.2
Eva Lonn, MD, MSc, FRCPC, FACC; Jackie Bosch, MD; and Salim Yusuf, MD, DPhil presented the findings at the 2016 American College of Cardiology (ACC) Scientific Sessions. The findings were simultaneously published in 3 separate reports in the New England Journal of Medicine.3
The Cardiology Advisor recently spoke with George Bakris, MD, professor of medicine and director of the University of Chicago Medicine American Society of Hypertension (ASH) Comprehensive Hypertension Center to elucidate the HOPE-3 findings and determine how they may influence clinical practice.
In comparison with SPRINT, which was composed of high-risk, older patients who were well-treated prior to entering the trial and then markedly improved during the course of aggressive treatment, HOPE-3 was more of a “first-line prevention trial,” Dr Bakris noted.