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Intensive blood pressure control in isolated systolic hypertension: a post hoc analysis of a cluster randomized trial
Chang Wang1, Songyue Liu1, Wei Miao1
1Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
Insights
Intensive blood pressure control to below 130/80 mmHg significantly reduced cardiovascular disease events in patients with isolated systolic hypertension (ISH). This approach proved effective and safe, offering a new strategy for managing ISH patients.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Isolated systolic hypertension (ISH) is common and associated with poor outcomes.
- Evidence for the benefits of intensive blood pressure (BP) control in ISH patients is limited.
- This study addresses the need for direct evidence on intensive BP management in ISH.
Purpose of the Study:
- To evaluate the efficacy and safety of intensive BP control targeting <130/80 mmHg in patients with ISH.
- To assess the impact of intensive BP control on cardiovascular disease (CVD) events.
Main Methods:
- Post hoc analysis of the China Rural Hypertension Control Project (CRHCP) involving patients with ISH (SBP ≥ 140 mmHg, DBP < 90 mmHg).
- Randomized patients into intensive BP control (<130/80 mmHg) or usual care groups.
- Primary outcome: composite CVD events (stroke, myocardial infarction, heart failure, CVD death). Analyzed using mixed-effect Cox regression and GEE models.
Main Results:
- Intensive BP control group achieved mean BP of 126.5/71.2 mmHg vs. 148.1/78.6 mmHg in usual care.
- Significantly lower composite CVD rate in the intensive group (1.52% vs. 2.30%/year; HR: 0.64; P < 0.001), including reduced stroke, heart failure, and CVD death.
- The primary outcome was reduced by 36% with intensive control; benefits were consistent across subgroups. Safety outcomes, including hypotension, did not significantly differ, except for a slight increase in hypotension in the intervention group.
Conclusions:
- Intensive blood pressure control targeting <130/80 mmHg is effective in preventing cardiovascular events in patients with isolated systolic hypertension.
- The intensive BP control strategy is safe for ISH patients, with no significant increase in major adverse safety outcomes.
- These findings support the adoption of intensive BP management for ISH patients to reduce CVD risk.
Background:
The isolated systolic hypertension (ISH) is of high prevalence, with a relatively poor prognosis. However, there is still no direct evidence to demonstrate the benefits of intensive blood pressure (BP) control among these patients. We aimed to evaluate intensive BP control with the target of <130/80 mmHg in ISH.
Methods:
This was a post hoc analysis of patients with ISH in the China Rural Hypertension Control Project (CRHCP), defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg. The primary outcome was cardiovascular disease (CVD) including stroke, myocardial infarction, heart failure, and CVD death. Mixed-effect Cox proportional regression and generalized estimating equation models were used for analysis.
Findings:
In total, 7981 patients were randomly assigned to the intervention group and 8005 to the usual care group between May 8 and November 27, 2018. The median follow-up was 3.02 years (25-75%: 2.98-3.06). Mean systolic/diastolic BP at the end of 36 months follow-up was 126.5/71.2 mmHg in the intensive BP control group and 148.1/78.6 mmHg in the usual care group. The intervention group presented a substantially lower rate of composite CVD compared with the usual care group (1.52% versus 2.30%/year; multiple-adjusted hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.57-0.72; P < 0.001), especially for stroke (multiple-adjusted HR: 0.61; 95% CI: 0.53-0.70; P < 0.001), HF (multiple-adjusted HR: 0.57; 95% CI: 0.36-0.91; P = 0.017) and CVD death (multiple-adjusted HR: 0.64; 95% CI: 0.50-0.83; P < 0.001). The primary composite outcome was substantially reduced by 36% in the intervention group compared with the usual care group. The further interaction analysis revealed that the reduction of primary outcome by intervention was consistent across subgroups of sex, age, education level, history of CVD, use of antihypertensive medication and baseline DBP (P > 0.05 for all interaction test). The incidences of symptomatic hypotension, syncope injurious falls and renal outcomes did not differ between the two groups, even though hypotension was increased in intervention group (RR:1.71; 95% CI: 1.28-2.28; P < 0.001).
Interpretation:
Intensive BP control (<130/80 mmHg) was effective and safe in patients with ISH for the prevention of CVD events.
Funding:
The Ministry of Science and Technology (China) of China and the Science and Technology Program of Liaoning Province, China.
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