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Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc
Adam P Bress1,2, Jordan B King3, Kathryn E Kreider4
1Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT adam.bress@hsc.utah.edu.
Insights
Intensive blood pressure treatment benefits were similar for individuals with prediabetes and normal blood sugar. This finding suggests that prediabetes status does not alter the cardiovascular protective effects of intensive systolic blood pressure management.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Prediabetes is a growing public health concern, often coexisting with hypertension.
- The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated benefits of intensive systolic blood pressure (SBP) treatment (<120 mmHg) over standard treatment (<140 mmHg).
- It remains unclear if prediabetes status modifies the cardiovascular benefits of intensive SBP treatment.
Purpose of the Study:
- To investigate whether the effects of intensive versus standard SBP treatment differ between participants with and without prediabetes at baseline in the SPRINT trial.
- To analyze the impact of prediabetes on cardiovascular outcomes and all-cause mortality in the context of intensive SBP management.
Main Methods:
- A post hoc analysis of the SPRINT trial data was conducted.
- Participants were categorized into two groups based on baseline fasting serum glucose: prediabetes (≥100 mg/dL) and normoglycemia (<100 mg/dL).
- Cox regression models were used to compare the hazard ratios for the primary composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiovascular death) and all-cause mortality between intensive and standard SBP treatment arms within each glucose category.
Main Results:
- The study included 9,361 participants, with 3,898 having prediabetes and 5,425 having normoglycemia.
- Intensive SBP treatment showed a reduced risk for the primary composite outcome in both groups (HR 0.69 for prediabetes, HR 0.83 for normoglycemia), with no significant interaction (P=0.30).
- Similar beneficial effects of intensive SBP treatment were observed for all-cause mortality and renal outcomes, irrespective of baseline prediabetes status (all P for interaction > 0.05).
Conclusions:
- The SPRINT trial demonstrated that intensive systolic blood pressure treatment provides similar cardiovascular benefits to individuals with prediabetes and those with normoglycemia.
- Prediabetes status does not appear to significantly modify the effectiveness of intensive SBP lowering on major adverse cardiovascular events or mortality.
- These findings support the application of intensive SBP management strategies across a broader hypertensive population, including those with prediabetes.
Objective:
To determine whether the effects of intensive (<120 mmHg) compared with standard (<140 mmHg) systolic blood pressure (SBP) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial (SPRINT).
Research Design And Methods:
This was a post hoc analysis of SPRINT. SPRINT participants were categorized by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose <100 mg/dL). The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment among those with prediabetes and normoglycemia.
Results:
Among 9,361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (P value for interaction 0.30). For all-cause mortality, the hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (P value for interaction 0.74). Effects of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia (all interaction P > 0.05).
Conclusions:
In SPRINT, the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia.
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