Optimal SBP targets in routine clinical care

Gitsels, Lisanne A., Kulinskaya, Elena, Bakbergenuly, Ilyas and Steel, Nicholas ORCID: https://orcid.org/0000-0003-1528-140X (2019) Optimal SBP targets in routine clinical care. Journal of Hypertension, 37 (4). 837–843. ISSN 0263-6352

Preview

PDF (Published manuscript) - Published Version Available under License Creative Commons Attribution. Download (246kB) | Preview

Abstract

Objective: Compare outcomes of intensive treatment of SBP to less than 120 mmHg versus standard treatment to less than 140 mmHg in the US clinical Systolic Blood Pressure Intervention Trial (SPRINT) with similar hypertensive patients managed in routine primary care in the United Kingdom. Methods: Hypertensive patients aged 50–90 without diabetes or chronic kidney disease (CKD) were selected in SPRINT and The Health Improvement Network (THIN) database. Patients were enrolled in 2010–2013 and followed-up to 2015 (SPRINT N = 4112; THIN N = 8631). Cox's proportional hazards regressions were fitted to estimate the hazard of all-cause mortality or CKD (main adverse effect) associated with intensive treatment, adjusted for sex, age, ethnicity, smoking, blood pressure, cardiovascular disease, aspirin, statin, number of antihypertensive drugs at baseline, change in number of antihypertensive drugs at trial entry, and clinical site. Results: Almost half of the patients had intensive treatment (43–45%). In SPRINT, intensive treatment was associated with a decreased hazard of mortality of 0.63 (0.43–0.92), while in THIN with an increased hazard of 1.66 (1.28–2.15). In THIN, this effect was time-dependent. Intensive treatment was associated with an increased hazard of CKD of 2.67 (1.74–4.11) in SPRINT and 1.35 (1.08–1.70) in THIN. In THIN, this effect differed by the number of antihypertensive drugs prescribed at baseline. Conclusion: It appears that intensive treatment of SBP may be harmful in the general population where all have access to routine healthcare as with the UK National Health Services, but could be beneficial in high-risk patients who are closely monitored.

Item Type:	Article
Uncontrolled Keywords:	systolic blood pressure,hypertension,antihypertensive treatment,chronic kidney disease,survival prospects,clinical guidelines,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Science > School of Computing Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Science > Research Groups > Data Science and Statistics Faculty of Medicine and Health Sciences > Research Centres > Business and Local Government Data Research Centre (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	17 Sep 2018 10:34
Last Modified:	19 Oct 2023 02:16
URI:	https://ueaeprints.uea.ac.uk/id/eprint/68301
DOI:	10.1097/HJH.0000000000001947

Downloads

Actions (login required)

View Item