Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing RIsk of Vascular evenTs (ESPRIT) Study

2019 ◽  
Author(s):  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Lowering ◽  
Vascular Events ◽  
Pressure Lowering

Abstract P261: Intensive Systolic Blood Pressure Lowering Will Prevent Over 100,000 Deaths Annually

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Holly Kramer ◽  
Adam Bress ◽  
Srinivasan Beddhu ◽  
Paul Muntner ◽  
Richard S Cooper
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Systolic Blood Pressure ◽  
Mortality Rates ◽  
Mortality Data ◽  
Blood Pressure Lowering ◽  
Cvd Risk ◽  
Pressure Lowering ◽  
Annual Mortality ◽  
The U.S

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) trial randomized 9,361 adults aged ≥50 years at high cardiovascular disease (CVD) risk without diabetes or stroke to intensive systolic blood pressure (SBP) lowering (≤120 mmHg) or standard SBP lowering (≤140 mmHg). After a median follow up of 3.26 years, all-cause mortality was 27% (95% CI 40%, 10%) lower with intensive SBP lowering. We estimated the potential number of prevented deaths with intensive SBP lowering in the U.S. population meeting SPRINT criteria. Methods: SPRINT eligibility criteria were applied to the National Health and Nutrition Examination Survey 1999-2006, a representative survey of the U.S. population, linked with the mortality data through December 2011. Eligibility included (1) age ≥50 years with (2) SBP 130-180 mmHg depending on number of antihypertensive classes being taken, and (3) presence of ≥1 CVD risk conditions (history of coronary heart disease, estimated glomerular filtration rate (eGFR) 20 to 59 ml/min/1.73 m 2 , 10-year Framingham risk score ≥15%, or age ≥75 years). Adults with diabetes, stroke history, >1 g/day proteinuria, heart failure, on dialysis, or eGFR<20 ml/min/1.73m 2 were excluded. Annual mortality rates for adults meeting SPRINT criteria were calculated using Kaplan-Meier methods and the expected reduction in mortality rates with intensive SBP lowering in SPRINT was used to determine the number of potential deaths prevented. Analyses accounted for the complex survey design. Results: An estimated 18.1 million U.S. adults met SPRINT criteria with 7.4 million taking blood pressure lowering medications. The mean age was 68.6 years and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.2% (95% CI 1.9%, 2.5%) and intensive SBP lowering was projected to prevent 107,453 deaths per year (95% CI 45,374 to 139,490). Among adults with SBP ≥145 mmHg, the annual mortality rate was 2.5% (95% CI 2.1%, 3.0%) and intensive SBP lowering was projected to prevent 60,908 deaths per year (95% CI 26, 455 to 76, 792). Conclusions: We project intensive SBP lowering could prevent over 100,000 deaths per year of intensive treatment.

Statistical analysis plan for pooled individual patient data from two landmark randomized trials (INTERACT2 and ATACH-II) of intensive blood pressure lowering treatment in acute intracerebral hemorrhage

2018 ◽  
Vol 14 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Tom J Moullaali ◽  
Xia Wang ◽  
Renee' H Martin ◽  
Virginia B Shipes ◽  
Adnan I Qureshi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Functional Recovery ◽  
Modified Rankin Scale ◽  
Blood Pressure Lowering ◽  
Safety Outcomes ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

Background There is persistent uncertainty over the benefits of early intensive systolic blood pressure lowering in acute intracerebral hemorrhage. In particular, over the timing, target, and intensity of systolic blood pressure control for optimum balance of potential benefits (i.e. functional recovery) and risks (e.g. cerebral ischemia). Aims To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage. Secondary aims are to identify the modifying effects of patient characteristics and an optimal systolic blood pressure lowering profile. Methods Individual participant data pooled analyses of two large, multicenter, randomized controlled trials specifically undertaken to assess the effects of early intensive systolic blood pressure reduction on clinical outcomes in acute intracerebral hemorrhage: the Intensive Blood Pressure in Acute Intracerebral Hemorrhage Trial (INTERACT2) and the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial. Combined data will include baseline characteristics; systolic blood pressure in the first 24 h; process of care measures; and key efficacy and safety outcomes. Outcomes The primary outcome is functional recovery, defined by an ordinal distribution of scores on the modified Rankin scale at 90 days post-randomization. Secondary outcomes include various standard binary cut-points for disability-free survival on the modified Rankin scale, and health-related quality of life at 90 days. Safety outcomes include symptomatic hypotension requiring corrective therapy and early neurologic deterioration within 24 h, and deaths, any serious adverse event, and cardiac and renal serious adverse events, within 90 days. Discussion A pre-determined protocol was developed to facilitate successful collaboration and reduce analysis bias arising from prior knowledge of the findings. Clinical trial registration URL: http://www.clinicaltrials.gov . Unique identifiers for INTERACT2 (NCT00716079) and ATACH-II (NCT01176565).

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