Article Text
Abstract
Introduction The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that closely controlling blood pressure (BP) could decrease cardiovascular outcome risk without increasing the orthostatic hypotension rate. We aimed to evaluate the association between baseline orthostatic BP change and major adverse cardiovascular event (MACE) occurrence.
Methods We conducted a post hoc analysis using SPRINT data including 9329 patients with hypertension. The SPRINT trial was a two-arm, multicentre, randomised clinical trial designed to test whether an intensive treatment aimed at reducing systolic BP (SBP) to <120 mm Hg would reduce cardiovascular disease risk. Orthostatic BP change was defined as baseline standing systolic BP (SBP)−baseline mean seated SBP, or diastolic BP (DBP)−baseline mean seated DBP.
Results We found a U-shaped relationship between orthostatic BP changes and MACE occurrence. All lowest risk points were around 0 mm Hg. On the left side of the inflection point, MACE risk decreased with orthostatic BP change decrease (HR=0.99, 95% CI (0.98 to 1.00), p=0.04, SBP change) (HR=0.97, 95% CI (0.95 to 0.99), p<0.01, DBP change); on the right side, MACE risk increased with orthostatic BP change increase (HR=1.02, 95% CI (1.01 to 1.06), p<0.01, SBP change) (HR=1.01, 95% CI (1.00 to 1.03), p=0.16, DBP change). There was no significant interaction effect between orthostatic SBP (p for interaction=0.37) or DBP changes (p for interaction=0.33) and intensive BP management.
Conclusions Orthostatic DBP increase and SBP decrease were associated with an increased MACE risk. The benefits of intensive BP management were also consistent across different orthostatic BP change ranges.
- hypertension
Data availability statement
Data may be obtained from a third party and are not publicly available. We obtained the anonymised data and materials of the SPRINT from the National Heart, Lung, and Blood Institute BioLINCC. The data can be accessed on reasonable request at https://biolincc.nhlbi.nih.gov/studies/sprint/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. We obtained the anonymised data and materials of the SPRINT from the National Heart, Lung, and Blood Institute BioLINCC. The data can be accessed on reasonable request at https://biolincc.nhlbi.nih.gov/studies/sprint/.
Footnotes
Contributors XH was the guarantor for this study. XH, X-LZ and JP designed the study and provided methodological expertise. JP drafted the manuscript. HZ, YL, JY, KZ and XW drafted the tables and figures and performed the statistical analysis. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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