Trajectories of Blood Pressure Control a Year After Randomization and Incident Cardiovascular Outcomes in SPRINT

Area of Science:

• Cardiology
• Clinical Trials
• Epidemiology

Background:

• Observational studies explored blood pressure trajectories and cardiovascular disease (CVD) risk.
• Few clinical trials have examined the association between systolic blood pressure (SBP) trajectories and CVD outcomes.

Purpose of the Study:

• To identify distinct systolic blood pressure (SBP) trajectories within a clinical trial cohort.
• To determine if identified SBP trajectory patterns are independently associated with CVD risk and all-cause mortality.

Main Methods:

• Latent class group-based modeling was used to identify SBP trajectories in the Systolic Blood Pressure Intervention Trial (SPRINT) cohort.
• SBP measures from the first 12 months post-randomization were incorporated.
• Cox proportional hazards models assessed the association between SBP trajectories and CVD/all-cause mortality.

Main Results:

• Four SBP trajectories were identified: low decline (41%), high decline (6%), low stable (48%), and high stable (5%).
• Compared to the low decline group, the low stable group had a 29% increased CVD risk (HR: 1.29, 95% CI: 1.06-1.57).
• The high stable group showed a 76% increased risk of all-cause mortality versus the low decline group (HR: 1.76, 95% CI: 1.15-2.68) and a 54% increased risk versus the low stable group (HR: 1.54, 95% CI: 1.05-2.28).

Conclusions:

• Systolic blood pressure (SBP) trajectory patterns are linked to significant cardiovascular outcomes, independent of baseline blood pressure.
• These findings may enhance identification of individuals at risk for CVD.
• Understanding SBP trajectories can aid in optimizing antihypertensive treatment strategies to prevent future cardiovascular events.