Targeting the Efficacy of Intensive Blood Pressure Treatment in Hypertensive Patients - An Exploratory Analysis of SPRINT.

BACKGROUND

Hypertensive patients show highly heterogeneous treatment effects (HTEs) and cardiovascular prognosis, and not all benefit from intensive blood pressure treatment.

METHODS AND RESULTS

We used the causal forest model to identify potential HTEs of patients in the Systolic Blood Pressure Intervention Trial (SPRINT). Cox regression was performed to assess hazard ratios (HRs) for cardiovascular disease (CVD) outcomes and to compare the effects of intensive treatment among groups. The model revealed 3 representative covariates and patients were partitioned into 4 subgroups: Group 1 (baseline body mass index [BMI] ≤28.32 kg/mand estimated glomerular filtration rate [eGFR] ≤69.53 mL/min/1.73 m); Group 2 (baseline BMI ≤28.32 kg/mand eGFR >69.53 mL/min/1.73 m); Group 3 (baseline BMI >28.32 kg/mand 10-year CVD risk ≤15.8%); Group 4 (baseline BMI >28.32 kg/mand 10-year CVD risk >15.8%). Intensive treatment was shown to be beneficial only in Group 2 (HR 0.54, 95% confidence interval [CI] 0.35-0.82; P=0.004) and Group 4 (HR 0.69, 95% CI 0.52-0.91; P=0.009).

CONCLUSIONS

Intensive treatment was effective for patients with high BMI and 10-year CVD risk, or low BMI and normal eGFR, but not for those with low BMI and eGFR, or high BMI and low 10-year CVD risk. Our study could facilitate the categorization of hypertensive patients, ensuring individualized therapy.