Is There an Ideal BP Target? Analysis Says It May Vary

The trial randomized those with systolic blood pressure ≥130mmHg to either intensive Tx or standard treatment
The trial randomized those with systolic blood pressure ≥130mmHg to either intensive Tx or standard treatment

Findings from a post-hoc analysis suggest there may be differing ideal blood pressure targets based on the patient's baseline pressure and overall cardiovascular risk. The data were presented at the European Society of Cardiology (ESC) Congress 2017 in Barcelona, Spain. 

According to the Systolic Blood Pressure Intervention Trial (SPRINT) data, patients who have systolic blood pressure reading of ≥160mmHg may benefit from a less stringent blood pressure control. Tzung-Dau Wang, MD, PhD, from National Taiwan University Hospital, stated, “The key message from our analysis is that a universal blood pressure target may not  be appropriate for all, and that for some with baseline SBP of 160mmHg or more, the harms of aggressive treatment might outweigh the benefits." 

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In SPRINT (n=9,361), all patients with systolic blood pressure ≥130mmHg were randomized to either intensive treatment (target <120mmHg) or standard treatment (target <140mmHg). Although data showed better overall outcomes with intensive treatment, it was suggested that aggressive blood pressure lowering may carry risks as well as benefits. 

The post-hoc analysis further investigated SPRINT study participants who had a systolic blood pressure ≥160mmHg (n=480). This subgroup's median 10-year Framingham risk score was ≤31.3%. After adjusting for age and gender, patients randomized to the aggressive treatment arm demonstrated triple the risk of mortality from any cause vs. patients who received less intense treatment (4.9% vs. 1.7%, hazard ratio [HR] 3.12, 95% CI: 1.00–9.69; P=0.012). These results, however, barely reached statistical significance.

The authors noted no increase in risk associated with intensive treatment among SPRINT study participants who had lower baseline systolic blood pressure. 

Dr. Wang and colleagues concluded, “It seems there was an intricate interaction between each individual's baseline blood pressure, their inherent cardiovascular risk, and their degree of blood pressure reduction - so we have to consider all three of these elements in managing hypertensive patients."

For more information visit escardio.org.