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

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d253663e180">Background:</h5> <p id="P2">Prior studies suggest benefits of blood pressure-lowering on cardiovascular risk may be attenuated in resistant hypertension compared to the general hypertensive population, but prospective data are lacking. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d253663e185">Methods:</h5> <p id="P3">We assessed intensive (&lt;120 mmHg) versus standard (&lt;140 mmHg) systolic blood pressure targets on adverse outcome risk according to baseline resistant hypertension status, using Action to Control Cardiovascular Risk in Diabetes (ACCORD-BP) and Systolic Blood Pressure Intervention Trial (SPRINT) patient-level data. Patients were categorized as having baseline apparent resistant hypertension (blood pressure ≥130/80 mmHg 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 two outcomes: myocardial infarction, stroke, cardiovascular death ± heart failure, and the same outcomes plus all-cause death, individually. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d253663e190">Results:</h5> <p id="P4">Among 14,094 patients, 2,710 (19.2%) had baseline apparent resistant hypertension. In adjusted models, an intensive target reduced risk of both outcomes (myocardial infarction/stroke/cardiovascular death: HR, 0.81; 95% CI, 0.71–0.93; myocardial infarction/stroke/heart failure/cardiovascular death: HR, 0.78; 95% CI, 0.69–0.88) as well as stroke (HR, 0.72; 95% CI, 0.55–0.94) and heart failure (HR, 0.73; 95% CI, 0.59–0.91). An intensive target also appeared to reduce myocardial infarction, cardiovascular death and all-cause death risk. Benefits were observed irrespective of baseline resistant hypertension status. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d253663e195">Conclusions:</h5> <p id="P5">Our findings provide the first evidence to support guidance to treat resistant hypertension to the same blood pressure goal as non-resistant hypertension. </p> </div>