Optimal SBP targets in routine clinical care

Gitsels, Lisanne A., Kulinskaya, Elena, Bakbergenuly, Ilyas and Steel, Nicholas (2019) Optimal SBP targets in routine clinical care. Journal of Hypertension, 37 (4). 837–843. ISSN 0263-6352

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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
Faculty \ School: Faculty of Science > School of Computing Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 17 Sep 2018 10:34
Last Modified: 18 Sep 2020 23:44
URI: https://ueaeprints.uea.ac.uk/id/eprint/68301
DOI: 10.1097/HJH.0000000000001947

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