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Randomized Controlled Trial
. 2018 Sep;20(9):1247-1252.
doi: 10.1111/jch.13346. Epub 2018 Jul 9.

Blood pressure variability predicts adverse events and cardiovascular outcomes in SPRINT

Kenechukwu Mezue  1   2 , Abhinav Goyal  2 , Gregg S Pressman  3 , Roy Matthew  4 , Jay C Horrow  5 , Janani Rangaswami  2   6
Affiliations
Randomized Controlled Trial

Blood pressure variability predicts adverse events and cardiovascular outcomes in SPRINT

Kenechukwu Mezue et al. J Clin Hypertens (Greenwich). 2018 Sep.

Abstract

SPRINT (Systolic Blood Pressure Intervention Trial) highlighted the benefits of intensive targeted antihypertensive therapy but resulted in higher rates of treatment-related adverse events. Blood pressure (BP) variability has emerged as a significant predictor of outcomes over and above levels of BP. Using the SPRINT data set, we aimed to determine the relationship of BP variability with cardiovascular outcomes and side effects of antihypertensive therapy. The analyses included all participants randomized in SPRINT who reached the target systolic BP (SBP) for their respective groups (intensive < 120 mm Hg; standard < 140 mm Hg). Coefficients of variation (CV) for SBP, diastolic BP (DBP), and PP for each patient characterized variability. Student t test was used to compare treatment arms for each CV metric. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome and adverse events. P < .15 on univariate analysis was required to enter the model and P < .05 to remain in it. A total of 8884 patients (4561 standard group; 4323 intensive group) met inclusion criteria. DBP CV differed between the groups (9.12 ± 3.20 standard group; 9.47 ± 3.49 intensive group [P < .0001]). DBP CV predicted a greater hazard for the primary outcome (hazard ratio [HR], 1.14) in the overall model as well as separate analyses by treatment arms (standard group HR, 1.15; intensive group HR, 1.19), each P < .0001. DBP CV also independently predicted a greater hazard for acute kidney injury (HR, 1.12) and hypotensive events (HR, 1.12). Visit-to-visit DBP variability independently predicted worse cardiovascular outcomes and hypoperfusion-related adverse events in SPRINT.

Keywords: blood pressure variability; cardiovascular outcomes; hypertension.

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Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Consort diagram leading to the subset of SPRINT participants in the current analyses. BP indicates blood pressure; SBP, systolic blood pressure
Figure 2
Figure 2
Kaplan‐Meier survival curves by quartiles of coefficient of variation (CV) for diastolic blood pressure (BP): for primary outcome (A), hypotension (B), and acute kidney injury (AKI) (C). “Landmark date” denotes the day (separate for each patient) when target BP was reached, as explained in the Methods section. Kaplan‐Meier curves were not constructed for syncope, as CV for diastolic BP was not a part of its final predictive model
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