Houston, TX—Stricter Systolic Pressure Intervention Trial (SPRINT) guidelines appear to offer great value to patients at higher risk for cardiovascular disease (CVD), but the advantages are outweighed by disadvantages in those at lower risk.

That’s according to a recent analysis published in the Journal of the American College of Cardiology, which notes that the lower rate of primary-outcome events in the intensive-treatment group in SPRINT was associated with increased clinically significant serious adverse events (SAEs).

However, in 2017, the American College of Cardiology and American Heart Association issued risk-based blood pressure treatment guidelines based on the research.

The analysis team, led by Robert A. Phillips, MD, PhD, chief medical officer at Houston Methodist Hospital, suggests that stratifying the SPRINT population by risk of future CVD might be a better way to identify those patients who would benefit most from intensive treatment.

“While it’s estimated that 107,500 deaths could be averted annually in the U.S. by implementing more aggressive treatments, it may be accompanied by other serious, adverse events,” Phillips said in a Houston Methodist press release. “This presents clinicians and patients with a dilemma, potentially trading one clinically significant condition for another.”

The SPRINT guidelines, written by a panel of 21 scientists and health experts who reviewed more than 900 published studies, classify hypertension as a reading of 130 over 80, rather than 140 over 90. Based on the new goals, nearly half—46%—of U.S. adults are now considered hypertensive, up from 32%.

“We developed a model using the 10-year cardiovascular disease risk and found that aggressive treatment of patients with a risk greater than or equal to 18.2 percent would result in more benefit than harm, while those with a risk of less than that would fare better under a standard blood pressure management approach,” Phillips explained.

The model indicates that, within each quartile, there was a lower rate of primary outcome events in the intensive-treatment group, with no differences in all-cause SAEs. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38, while the number needed to harm for all-cause SAEs increased from 62 to 250.

The predictive model demonstrated significantly increasing benefit-to-harm ratios (± SE) of 0.50 ± 0.15, 0.78 ± 0.26, 2.13 ± 0.73, and 4.80 ± 1.86 for the first, second, third, and fourth quartiles, respectively (P for trend <.001), according to the article.

“With 2017 American College of Cardiology/American Heart Association blood pressure treatment guidelines, this analysis may help providers and patients make decisions regarding the intensity of blood pressure treatment,” the study authors concluded.

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