Achieving Intensive Blood Pressure Control in High-Risk Patients: Implementation Insights From the ESPRIT Trial.

Area of Science:

• Cardiology
• Public Health
• Clinical Trials

Background:

• Inadequate blood pressure (BP) control is a global health challenge.
• Limited evidence exists on implementing systolic BP (SBP) <120 mm Hg targets in real-world settings.

Purpose of the Study:

• To evaluate the implementation and effect heterogeneity of targeting SBP <120 mm Hg in diverse hypertensive patients with high cardiovascular risk.
• To specifically assess outcomes in patients with longstanding uncontrolled BP.

Main Methods:

• Analysis of data from the ESPRIT trial (N=11,255).
• Examined achieved SBP levels, time to intensive control, medication use, clinic visit frequency, and major clinical outcomes.
• Subgroup analyses were performed based on patient characteristics and hypertension history.

Main Results:

• Median SBP in the intensive arm was 117 mm Hg, with 62.5% achieving intensive BP control.
• Factors like older age, male sex, higher baseline SBP, longer hypertension duration, stroke, diabetes, and higher baseline medication use were associated with less likelihood of sustained intensive control.
• The median time to intensive control was 62 days; intensive control required more medications and clinic visits in the first year compared to standard care.

Conclusions:

• Sustaining SBP <120 mm Hg is achievable for diverse high-risk hypertensive patients, including those with longstanding uncontrolled BP, using modest additional medical resources.
• Implementing ESPRIT trial evidence can enhance BP control and decrease global cardiovascular burden.
• The study provides evidence for the feasibility and resource implications of intensive BP management strategies.