Time in systolic BP target range predicts major CV event risk
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Among adults with hypertension and high CV risk, greater time with systolic BP within target range predicted reduced risk for major CV events independent of traditional CV risk factors, researchers reported.
Systolic BP time in target range remained an important predictor of CV outcomes even after adjusting for mean systolic BP and systolic BP variability, whereas systolic BP time in target range predicted CV outcomes even among participants with a mean systolic BP within target range, the researchers wrote.
The study was a post hoc analysis of SPRINT that compared intensive (target of < 120 mm Hg) and standard (target of < 140 mm Hg) systolic BP treatment interventions in 6,162 adults with hypertension and high CV risk (mean age, 68 years; 38% women; 17% with history of clinical CVD).
According to the researchers, participants with greater time in target range were younger, had lower 10-year CV risk and lower baseline systolic BP and were more likely to be women and statin users compared with those with lower time in target range. Each 1-standard deviation (SD) increase in time in target range conferred lower risk for first major adverse CV events in fully adjusted models (HR per 1 SD = 0.81; 95% CI, 0.73-0.91; P < .001).
Greater time in target systolic BP range also reduced risk for the following: nonfatal MI (HR per 1 SD = 0.75; 95% CI, 0.62-0.9; P = .002); HF hospitalization (HR per 1 SD = 0.79; 95% CI, 0.65-0.97; P = .023) and major adverse CV events or death (HR per 1 SD = 0.85; 95% CI, 0.78-0.95; P = .001), the researchers wrote.
“These results suggest that time in target range provides incremental value beyond mean systolic blood pressure to population-based hypertension quality monitoring and clinical trial-based blood pressure interventions,” the researchers wrote.
Perspective
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Randall Zusman, MD
The major take-home message of this study is that consistent BP control is rewarded with a reduction in CV events.
That’s important for patients to understand, because noncompliance with medications and feeling that they can start and stop medications without consequence is a problem that I often face in the care of my patients.
I encourage my patients to take their medication as prescribed regularly, day after day, and not to let themselves run out of their medications and be without therapy for any prolonged period of time.
It’s also important to stress the need of monitoring BP at home so that we are aware that their BP is being well controlled the majority of time in the normal living circumstance.
Going forward, this study gives me one more argument and one more strong point to make when I talk to patients about the importance of controlling their BP.
There are those patients for whom BP is well controlled, they are on one or two drugs, everything is great, and they have no side effects. But then there are patients whose BP is labile, and they are reluctant to take their medications as prescribed. They may not follow recommendations with regard to their diet, their salt intake or their exercise activities.
This study gives me additional information and additional ammunition to encourage them to control their BP consistently at the levels that we are hoping to achieve so that we reduce their risk for MI, stroke, HF or other complications of hypertension.
Hopefully, this will lead to more data through monitoring a patient population with some of the new devices out there. There are some exciting, new monitoring devices that allow patients to measure their BP without necessarily putting a sphygmomanometer on their arm.
By using less intrusive, less time-consuming techniques, BP values could be measured during a whole range of physical activities.
I’m also supportive of the use of nondrug therapies for the control of hypertension. We use relaxation response as a very effective technique for BP control. We are investigating renal denervation, which is an invasive but potentially curative therapy for high BP.
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