Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Am J Hypertens. 2023 Aug 5;36(9):498-508. doi: 10.1093/ajh/hpad047.
The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated an intensive (<120 mm Hg) vs. standard (<140 mm Hg) systolic blood pressure (SBP) goal lowered cardiovascular disease (CVD) risk. Estimating the effect of intensive SBP lowering among SPRINT-eligible adults most likely to benefit can guide implementation efforts.
We studied SPRINT participants and SPRINT-eligible participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study and National Health and Nutrition Examination Surveys (NHANES). A published algorithm of predicted CVD benefit with intensive SBP treatment was used to categorize participants into low, medium, or high predicted benefit. CVD event rates were estimated with intensive and standard treatment.
Median age was 67.0, 72.0, and 64.0 years in SPRINT, SPRINT-eligible REGARDS, and SPRINT-eligible NHANES participants, respectively. The proportion with high predicted benefit was 33.0% in SPRINT, 39.0% in SPRINT-eligible REGARDS, and 23.5% in SPRINT-eligible NHANES. The estimated difference in CVD event rate (standard minus intensive) was 7.0 (95% confidence interval [CI] 3.4-10.7), 8.4 (95% CI 8.2-8.5), and 6.1 (95% CI 5.9-6.3) per 1,000 person-years in SPRINT, SPRINT-eligible REGARDS participants, and SPRINT-eligible NHANES participants, respectively (median 3.2-year follow-up). Intensive SBP treatment could prevent 84,300 (95% CI 80,800-87,920) CVD events per year in 14.1 million SPRINT-eligible US adults; 29,400 and 28,600 would be in 7.0 million individuals with medium or high predicted benefit, respectively.
Most of the population health benefit from intensive SBP goals could be achieved by treating those characterized by a previously published algorithm as having medium or high predicted benefit.
收缩压干预试验（SPRINT）表明，强化（<120mmHg）与标准（<140mmHg）收缩压（SBP）目标降低了心血管疾病（CVD）的风险。估计 SPRINT 中最有可能受益的合格成年人强化 SBP 降低的效果可以指导实施工作。
我们研究了 SPRINT 参与者和 SPRINT 合格的 REGARDS 研究和国家健康和营养检查调查（NHANES）参与者。使用已发表的强化 SBP 治疗预测 CVD 获益的算法将参与者分为低、中或高预测获益。使用强化和标准治疗估计 CVD 事件发生率。
SPRINT、SPRINT 合格的 REGARDS 和 SPRINT 合格的 NHANES 参与者的中位年龄分别为 67.0、72.0 和 64.0 岁。高预测获益的比例分别为 SPRINT 中的 33.0%、SPRINT 合格的 REGARDS 中的 39.0%和 SPRINT 合格的 NHANES 中的 23.5%。CVD 事件发生率（标准减去强化）的估计差异分别为 SPRINT 中的 7.0（95%置信区间[CI]3.4-10.7）、SPRINT 合格的 REGARDS 参与者中的 8.4（95%CI8.2-8.5）和 SPRINT 合格的 NHANES 参与者中的 6.1（95%CI5.9-6.3）/1000 人年（中位随访时间 3.2 年）。强化 SBP 治疗每年可预防 1410 万 SPRINT 合格的美国成年人中的 84300（95%CI80800-87920）CVD 事件；分别有 29400 和 28600 人将在具有中等或高预测获益的 700 万人中。
通过治疗具有先前发表的算法特征的个体为中等或高预测获益，强化 SBP 目标可以实现大部分人群健康获益。
