Lifelong commitment to controlling BP must for continued CV benefits: JAMA

The findings underscore the importance of consistent long-term hypertension management.

Published findings from the SPRINT TRIAL in 2015 showed that intensive BP management reduced cardiovascular disease and death risk. In 2019, the SPRINT MIND trial showed that lowering blood pressure also reduced mild cognitive impairment risk in older adults.

In the recent study by Byron C. Jaeger, the team aimed to investigate the long-term effects of randomization to intensive treatment with the incidence of cardiovascular and all-cause mortality approximately 4.5 years following the trial's completion.

The randomization of the secondary analysis of a multicenter randomized clinical trial began on November 8, 2010; the trial ended on August 20, 2015. The study included patients 50 years and older with hypertension and increased CV risk but without diabetes or a history of stroke from 102 US and Puerto Rico clinic sites. Analyses were performed between October 2021 and February 2022.

The participants were randomized to the goal of systolic blood pressure (SBP) of less than 120 mm Hg (intensive treatment group; n = 4678) vs. less than 140 mm Hg (standard treatment group; n = 4683).

Extended observational follow-up for mortality was done via the US National Death Index from 2016 through 2020. Examination of outpatient SBP from electronic health records was done during and after the trial in a subset of 2944 trial participants.

The study led to the following findings:

• Among 9361 randomized participants, the mean age was 67.9 years, and 35.6% were women.
• Over a median intervention period of 3.3 years, intensive treatment was beneficial for both cardiovascular mortality (hazard ratio [HR], 0.66) and all-cause mortality (HR, 0.83).
• At the median total follow-up of 8.8 years, there was no longer evidence of benefit for cardiovascular mortality (HR, 1.02) or all-cause mortality (HR, 1.08).
• In a subgroup of participants, the estimated mean outpatient SBP among participants randomized to intensive treatment increased from 132.8 mm Hg at five years to 140.4 mm Hg at ten years following randomization.

"The beneficial effect of intensive blood pressure control on cardiovascular and all-cause mortality did not persist after the trial," the researchers wrote in their conclusion. "Given high outpatient systolic blood pressure levels in patients randomized to intensive treatment following the trial, these findings highlight the importance of consistent long-term hypertension management."

Reference:

Jaeger BC, Bress AP, Bundy JD, et al. Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. Published online October 12, 2022. doi:10.1001/jamacardio.2022.3345