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Randomized Controlled Trial
. 2017 Jan;69(1):42-50.
doi: 10.1161/HYPERTENSIONAHA.116.08076. Epub 2016 Nov 14.

Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study

Paul E Drawz  1 , Nicholas M Pajewski  2 , Jeffrey T Bates  2 , Natalie A Bello  2 , William C Cushman  2 , Jamie P Dwyer  2 , Lawrence J Fine  2 , David C Goff Jr  2 , William E Haley  2 , Marie Krousel-Wood  2 , Andrew McWilliams  2 , Dena E Rifkin  2 , Yelena Slinin  2 , Addison Taylor  2 , Raymond Townsend  2 , Barry Wall  2 , Jackson T Wright  2 , Mahboob Rahman  2
Affiliations
Randomized Controlled Trial

Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study

Paul E Drawz et al. Hypertension. 2017 Jan.

Abstract

The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249.

Keywords: blood pressure; circadian rhythm; goals; hypertension; stroke.

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Conflict of interest statement

The remaining authors report no conflicts of interest.

Figures

Figure 1
Figure 1
SPRINT indicates Systolic Blood Pressure Intervention Trial; ABPM, Ambulatory blood pressure monitoring.
Figure 2
Figure 2
Nighttime readings defined as being between 1:00 am and 6:00 am. Delta SBP denotes the mean difference in systolic blood pressure between the standard-treatment group and the intensive-treatment group. CKD indicates chronic kidney disease; SBP, systolic blood pressure.
Figure 3
Figure 3
Daytime readings defined as being between 9:00 am and 9:00 pm. Single dash lines represent mean difference in BP and dash-dot lines denote limits of agreement (±1.96 × SD of difference). Solid lines denote estimated regression fit based on local polynomial regression with 95% point-wise confidence intervals (shaded areas). SBP indicates systolic blood pressure.
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