Intensive blood pressure control in patients with a history of heart failure: the Systolic Blood Pressure Intervention Trial (SPRINT).

Abstract

The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced cardiovascular morbidity and mortality in high-risk patients.1 Effects were consistent among patients with and without prevalent cardiovascular disease. Patients with heart failure may benefit from intensive BP control by slowing the adverse cardiac remodelling associated with high BP. Conversely, some studies have suggested better outcomes among patients with heart failure who have higher BP.2 Therefore, it remains unknown whether a history of heart failure modifies the risks and benefits of intensive BP control. SPRINT randomized 9361 individuals who were ≥50 years of age, at high cardiovascular risk, and had a systolic BP of 130–180 mmHg to intensive or standard BP control.1 Pertinent exclusion criteria included diabetes, prior stroke, and known symptomatic heart failure within the past 6 months or a left ventricular ejection fraction <35%. The primary endpoint was the composite of acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. The principal safety endpoint was composite serious adverse events. We used multivariable Cox proportional hazards regression to determine the risk of efficacy and safety events in patients with baseline heart failure. We then calculated the efficacy and safety of intensive versus standard BP control in patients with and without baseline heart failure and examined subgroup heterogeneity using the likelihood-ratio test. A waiver for secondary use of the SPRINT data set was obtained from the Brigham and Women’s Hospital Institutional Review Board. Of the 9361 participants, 326 (3.5%) reported a history of heart failure. The prevalence did not significantly differ between patients randomized to intensive versus standard BP control [166 (3.6%) vs. 160 (3.4%); P = 0.73]. Median follow-up duration was 3.26 years (range 0–4.77 years). A history of heart failure was independently associated with