Optimal SBP targets in routine clinical care

Area of Science:

• Cardiology
• Public Health
• Clinical Trials

Background:

• The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated benefits of intensive systolic blood pressure (SBP) treatment (<120 mmHg) in US patients.
• Routine primary care in the UK National Health Service (NHS) differs significantly from the intensive monitoring in SPRINT.
• This study compares SPRINT outcomes to similar hypertensive patients in UK primary care.

Purpose of the Study:

• To compare the outcomes of intensive SBP treatment versus standard treatment in hypertensive patients managed in UK primary care.
• To evaluate the safety and efficacy of intensive blood pressure targets in a real-world healthcare setting.

Main Methods:

• A comparative study using data from the SPRINT trial (US) and The Health Improvement Network (THIN) database (UK).
• Included hypertensive patients aged 50-90 without diabetes or chronic kidney disease (CKD).
• Utilized Cox's proportional hazards regressions to analyze hazards of all-cause mortality and CKD.

Main Results:

• Intensive SBP treatment showed decreased mortality hazard in SPRINT (0.63) but increased hazard in THIN (1.66).
• Intensive treatment increased CKD hazard in both SPRINT (2.67) and THIN (1.35).
• The effect of intensive treatment varied based on the number of antihypertensive drugs prescribed at baseline in the UK cohort.

Conclusions:

• Intensive SBP treatment may be harmful in the general UK population receiving routine care.
• Intensive SBP treatment could be beneficial for high-risk patients under close monitoring.
• Real-world healthcare settings may influence the outcomes of intensive blood pressure management strategies.