Using PREVENT Equations to Compare Intensive vs Standard Systolic Blood Pressure Control for Primary Prevention in...

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• The PREVENT equations offer improved cardiovascular disease (CVD) risk stratification by including estimated glomerular filtration rate and total CVD events.
• Unlike older calculators, PREVENT excludes race and captures heart failure as a CVD event.

Purpose of the Study:

• To evaluate the relative and absolute benefits and harms of intensive versus standard systolic blood pressure (SBP) treatment.
• To stratify these benefits and harms according to the new PREVENT risk levels.

Main Methods:

• A secondary analysis of the SPRINT trial was conducted on participants without prevalent CVD.
• PREVENT 10-year CVD risk was calculated and categorized as low/borderline (<7.5%), intermediate (7.5%–<20%), and high (≥20%).
• Hazard ratios (HRs) and absolute risk differences for intensive (<120 mm Hg) vs. standard (<140 mm Hg) SBP treatment were estimated for CVD events and serious adverse events.

Main Results:

• Relative risk reductions for CVD events with intensive SBP treatment were consistent across PREVENT risk strata (HRs ranging from 0.70 to 0.85).
• Absolute risk differences for CVD events over 4 years varied significantly, from 0.002 in the low/borderline group to 0.024 in the high-risk group.
• No significant interaction was observed for serious adverse events across PREVENT strata (P for interaction = 0.44).

Conclusions:

• Intensive SBP treatment provides consistent relative CVD risk reduction across PREVENT risk groups.
• Absolute benefits of intensive SBP treatment are substantially greater in high-risk individuals.
• The PREVENT equation is valuable for identifying individuals who will benefit most from intensive SBP control for primary prevention.