Intensive BP reduction may reduce HF risk
Click Here to Manage Email Alerts
Patients assigned intensive BP reduction had a significant reduction in new-onset acute HF and mortality, according to an analysis of the SPRINT trial published in JACC: Heart Failure.
These reductions were not caused by the withdrawal of diuretic agents from patients assigned standard treatment or the differential use of diuretics between both groups, according to the study.
SPRINT trial data
Bharathi Upadhya, MD, associate professor of cardiology at Wake Forest School of Medicine, and colleagues analyzed data from 9,361 patients (mean age, 68 years) from the SPRINT trial who were 50 years or older with a systolic BP greater than 130 mm Hg. These patients were also free from diabetes or stroke and had increased risk for CV events.
As Healio previously reported, the SPRINT trial found that a systolic BP target of less than 120 mm Hg was associated with lower rates of death and CV events compared with a target of less than 140 mm Hg.
Patients were assigned a standard treatment regimen with a systolic BP target of less than 140 mm Hg (n = 4,683) or an intensive treatment regimen with a systolic BP target of less than 120 mm Hg (n = 4,678). Laboratory data, clinical information and antihypertensive medications were collected at screening, monthly for the first 3 months and every 3 months for the rest of the trial. All clinical events including acute decompensated HF were assessed every 3 months.
Of the patients in the study, 173 developed acute decompensated HF, of whom 105 were in the standard arm and 68 were in the intensive arm (HR = 0.63; 95% CI, 0.47-0.86).
The patients from the standard arm who were prescribed diuretics increased from 45% during the screen period to 50% when the intervention was initiated, then decreased to approximately 45% for the rest of the trial. In contrast, use in the intensive arm increased from 43% to 63%, then stabilized to 70% for the duration of the trial. The use of diuretics was steady throughout the trial in both arms.
Patients in the standard arm who never had an acute decompensated HF event had the lowest use of diuretic agents. Most of the events associated with HF occurred in patients who took diuretic therapy at the last visit before the event occurred.
At baseline, withdrawal of diuretic agents occurred in 6.1% of patients in the standard arm vs. 2.3% of those in the intensive arm. Eleven patients who withdrew from diuretic agents developed acute decompensated HF, 10 of whom were in the standard arm. One of these patients developed HF less than 1 month after diuretic withdrawal. When these 11 patients with excluded, the benefit of acute decompensated HF reduction continued to be significant (HR = 0.69; 95% CI, 0.5-0.94).
Diuretic use
Potassium-sparing diuretic agents (2%) and loop diuretic agents (< 6%) were not used often.
The use of diuretic agents was not a predictor for acute decompensated HF (HR = 0.96; 95% CI, 0.66-1.4).
“These results are concordant with hypertension trials that have shown that effective treatment of hypertension is a highly effective strategy for preventing HF, particularly among older adults who had systolic hypertension and HF are highly prevalent and associated with poor outcomes,” Upadhya and colleagues wrote. – by Darlene Dobkowski
Disclosures: The SPRINT trial was funded by the NIH. Upadhya reports she has financial arrangements with Corvia and Novartis. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to Top
Carl J. Pepine, MD, MACC
This work provides more support for these lower BP goals with this prevalent, modifiable risk factor that is too often taken for granted.
Also important in the hypertension space is the new analysis from ARIC (McEvoy JW, et al. JAMA. 2020;doi:10.1001/jama.2019.21402) indicating that recent concerns for possible increased risk associated with the lower diastolic BP goal may not be confirmed.
Read more about
Click Here to Manage Email Alerts