Optimal Systolic Blood Pressure Target in Resistant and Non-Resistant Hypertension: A Pooled Analysis of Patient-Level Data from SPRINT and ACCORD

The American Journal of Medicine
Steven M SmithRhonda M Cooper-DeHoff

Abstract

Prior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking. We assessed intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets on adverse outcome risk according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Systolic Blood Pressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (blood pressure ≥130/80 mm Hg while using 3 antihypertensive drugs or use of ≥4 drugs regardless of blood pressure) or non-resistant hypertension (all others). Cox regression was used to assess effects of treatment assignment, resistant hypertension status, their interaction, and other covariates, on first occurrence of 2 outcomes: myocardial infarction, stroke, cardiovascular death ± heart failure, and the same outcomes plus all-cause death, individually. Among 14,094 patients, 2710 (19.2%) had baseline apparent resistant hypertension. In adjusted models, an intensive target reduced risk of both outcomes (myocardial infarct...Continue Reading

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Citations

Jun 5, 2019·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Nasratullah Wahidi, Alan J Lerner
Jan 10, 2020·Current Hypertension Reports·Wilbert S Aronow
Oct 18, 2019·Current Hypertension Reviews·Guillaume LamiraultNantes University Hospital Working Group On Hypertension
Apr 23, 2020·Future Cardiology·Wilbert S Aronow
May 27, 2020·Current Opinion in Cardiology·Katherine E Di Palo
Sep 21, 2021·American Journal of Hypertension·Fabio AngeliPaolo Verdecchia

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