BACKGROUND: Cumulative evidence supports the beneficial effects of intensive blood pressure (BP)-lowering treatment to prevent cardiovascular events and death; however, the effects of a more aggressive BP target on health-related quality of life (HRQoL) remain unclear.
OBJECTIVES: This study aimed to compare the effects of intensive vs standard BP-lowering treatment strategies on long-term change in HRQoL among hypertensive patients with high cardiovascular risk.
METHODS: The ESPRIT (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events) trial was an open-label, blinded-outcome, randomized controlled trial. Participants were randomly assigned to receive either intensive BP-lowering treatment (targeting standard office systolic blood pressure [SBP] to <120 mm Hg) or standard BP-lowering treatment (targeting office SBP to <140 mm Hg). HRQoL was assessed by using the 5-level EuroQol Five Dimensions Questionnaire (EQ-5D-5L) at baseline and the final follow-up visit. Covariance analyses were applied to evaluate the effect of treatment assignment on changes in HRQoL.
RESULTS: The current study included 5,398 participants in the intensive treatment group and 5,406 participants in the standard treatment group. Over 3.4 years of follow-up, the EQ-5D visual analog scale scores increased by 0.56 point in the intensive treatment group and decreased by 0.50 point in the standard treatment group, resulting in a mean difference of 1.26 (95% CI: 0.55 to 1.98; P < 0.001). Compared with the standard treatment, the intensive treatment was associated with a 16% higher likelihood of meaningful improvement than worsening in EQ-5D visual analog scale (relative risk: 1.16; 95% CI: 1.04-1.30; P = 0.007). Categorical changes from baseline to the final follow-up visit in 5 domains between the 2 groups showed no statistical differences.
CONCLUSIONS: Intensive BP treatment, targeting office SBP to <120 mm Hg, produced modest benefits to HRQoL among hypertensive patients with high cardiovascular risk. (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events [ESPRIT]; NCT04030234).
| Discipline Area | Score |
|---|---|
| Internal Medicine |  |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) | |
| Cardiology |  |
Inconclusive (expected) results but with an interesting trend to be tested in a longer follow-up and in frail people. This study has only a follow-up a little longer than 3 years in a population with a mean age (64.6 years) where frailty is not so prevalent.
Very few large trials study QoL directly. Overall, given the burden of additional follow-up and additional medication, this result is good news. Most chronic therapies we use do not have a large impact on QoL, especially for elderly patients.
