Boston—The Systolic Blood Pressure Intervention Trial (SPRINT) results reported in 2015 suggested that overall death rates may be reduced by 27% for adults at high cardiovascular risk who receive intensive hypertension treatment.
Now, a new study in JAMA Cardiology puts that in different terms. A secondary analysis of SPRINT, a randomized clinical trial, applied age-based methods and assumed consistent treatment responses over time to estimate that intensive blood pressure (BP) control improves projected survival by 6 months to 3 years, depending on the age at which this treatment strategy is started.
“When physicians discuss optimizing blood pressure, patients often wonder what benefits they may anticipate with intensive blood pressure control,” said lead author Muthiah Vaduganathan, MD, MPH, a cardiologist at Brigham and Women’s Hospital. “That was the inspiration for our work: We’ve taken the data and reframed it to contextualize the results in a way that’s most meaningful to patients.”
Background information in the articles notes that high BP is a leading contributor to premature mortality worldwide. To estimate residual life span and potential survival gains with intensive, compared with standard, BP control in the SPRINT trial, the study team used validated, nonparametric age-based methods.
The secondary analysis included data from 102 enrolling clinical sites in the United States and involved 9,361 adults who were aged 50 years or older, were at high cardiovascular risk but without diabetes, and had a screening systolic BP between 130 and 180 mmHg. Mean age at randomization was 68 years; 64.4% of the patients were men, and 57.7% were non-Hispanic whites.
Participants were enrolled between November 2010 and March 2013, with data analysis occurring from May 2019 to December 2019. The authors explain that they calculated age-based estimates of projected survival (at a given age) using baseline age rather than time from randomization as the time axis.
Researchers report that, at age 50 years, the estimated residual survival was 37.3 years with intensive treatment and 34.4 years with standard treatment (difference, 2.9 years [95% CI, 0.9-5.0 years]; P = .008).
At age 65 years, meanwhile, residual survival was 24.5 years with intensive treatment and 23.3 years with standard treatment (difference, 1.1 years [95% CI, 0.1-2.1 years]; P = .03). The difference was 9 months for those aged 80 years.
While absolute survival gains with intensive versus standard BP control decreased with age, the authors point out, the relative benefits were consistent—4% to 9%.
“Intensive BP control improves projected survival by 6 months to 3 years among middle-aged and older adults at high cardiovascular risk but without diabetes mellitus. These post hoc actuarial analyses from SPRINT support the survival benefits of intensive BP control, especially among middle-aged adults at risk,” the study concludes.
The authors explain that the analysis did not account for potential risks, including kidney injury and low blood pressure, that are associated with intensive blood pressure control, adding,
“Estimates of survival benefits must be carefully weighed against these potential risks in the selection of blood pressure targets for individual patients.”
“Our hope is that these findings offer a more easily communicated message when discussing the potential benefits and risks of sustained blood pressure control over time,” Dr. Vaduganathan said. “These statistics about life expectancy may be more tangible and personalized for patients and more relatable when making these decisions.”
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Now, a new study in JAMA Cardiology puts that in different terms. A secondary analysis of SPRINT, a randomized clinical trial, applied age-based methods and assumed consistent treatment responses over time to estimate that intensive blood pressure (BP) control improves projected survival by 6 months to 3 years, depending on the age at which this treatment strategy is started.
“When physicians discuss optimizing blood pressure, patients often wonder what benefits they may anticipate with intensive blood pressure control,” said lead author Muthiah Vaduganathan, MD, MPH, a cardiologist at Brigham and Women’s Hospital. “That was the inspiration for our work: We’ve taken the data and reframed it to contextualize the results in a way that’s most meaningful to patients.”
Background information in the articles notes that high BP is a leading contributor to premature mortality worldwide. To estimate residual life span and potential survival gains with intensive, compared with standard, BP control in the SPRINT trial, the study team used validated, nonparametric age-based methods.
The secondary analysis included data from 102 enrolling clinical sites in the United States and involved 9,361 adults who were aged 50 years or older, were at high cardiovascular risk but without diabetes, and had a screening systolic BP between 130 and 180 mmHg. Mean age at randomization was 68 years; 64.4% of the patients were men, and 57.7% were non-Hispanic whites.
Participants were enrolled between November 2010 and March 2013, with data analysis occurring from May 2019 to December 2019. The authors explain that they calculated age-based estimates of projected survival (at a given age) using baseline age rather than time from randomization as the time axis.
Researchers report that, at age 50 years, the estimated residual survival was 37.3 years with intensive treatment and 34.4 years with standard treatment (difference, 2.9 years [95% CI, 0.9-5.0 years]; P = .008).
At age 65 years, meanwhile, residual survival was 24.5 years with intensive treatment and 23.3 years with standard treatment (difference, 1.1 years [95% CI, 0.1-2.1 years]; P = .03). The difference was 9 months for those aged 80 years.
While absolute survival gains with intensive versus standard BP control decreased with age, the authors point out, the relative benefits were consistent—4% to 9%.
“Intensive BP control improves projected survival by 6 months to 3 years among middle-aged and older adults at high cardiovascular risk but without diabetes mellitus. These post hoc actuarial analyses from SPRINT support the survival benefits of intensive BP control, especially among middle-aged adults at risk,” the study concludes.
The authors explain that the analysis did not account for potential risks, including kidney injury and low blood pressure, that are associated with intensive blood pressure control, adding,
“Estimates of survival benefits must be carefully weighed against these potential risks in the selection of blood pressure targets for individual patients.”
“Our hope is that these findings offer a more easily communicated message when discussing the potential benefits and risks of sustained blood pressure control over time,” Dr. Vaduganathan said. “These statistics about life expectancy may be more tangible and personalized for patients and more relatable when making these decisions.”
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