Comparison of Frequency of Atherosclerotic Cardiovascular Disease Events Among Primary and Secondary Prevention Subgroups of the Systolic Blood Pressure Intervention Trial
Section snippets
Methods
SPRINT was an open label randomized controlled trial conducted at 102 centers in the United States and its territories. Eligible adults with systolic hypertension (systolic BP 130 to 180 mm Hg) and ≥1 risk factor for cardiovascular disease (CVD) or previous CVD but without diabetes mellitus or previous stroke. Details of SPRINT and the primary outcomes have been published elsewhere.7,8 Risk factors for CVD included clinical CVD (excluding stroke), subclinical CVD, chronic kidney disease with
Results
Of the 9,361 SPRINT participants, we excluded 52 (0.5%) for missing data required for the PCE and 1,158 (12%) for age ≥80 years. The final analytic population was 8,151 participants, 6,874 without previous CVD (84%) and 1,127 with previous ASCVD (16%). Median (interquartile range) follow-up was 3.2 (2.7 to 3.8) years. Characteristics of trial participants by primary and secondary prevention populations and by 10-year risk range appear in Table 1. Overall mean ± standard deviation (SD) age was
Discussion
We observed a 2.51-fold increased hazard of ASCVD events among SPRINT participants in the secondary prevention population when compared with the primary prevention population. When compared by category of PCE-predicted 10-year ASCVD risk, the secondary prevention population experienced more incident ASCVD events across the spectrum of predicted risk than the primary prevention population. The burden of events experienced in the secondary prevention population was largest among those with the
Disclosures
The authors have no conflicts of interest to disclose.
Acknowledgment
The authors would like to thank participants and investigators of SPRINT. The authors thank the staff of the NHLBI BioLINCC for providing support for this analysis.
References (19)
- et al.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2014) - et al.
2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2014) - et al.
2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
J Am Coll Cardiol
(2019) - et al.
Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension
J Am Coll Cardiol
(2018) - et al.
Comparison of frequency of atherosclerotic cardiovascular and safety events with systolic blood pressure <120 mm hg versus 135-139 mm hg in a Systolic Blood Pressure Intervention Trial primary prevention subgroup
Am J Cardiol
(2018) - et al.
A general cardiovascular risk profile: the Framingham Study
Am J Cardiol
(1976) - et al.
Utility of the Framingham Risk score in predicting secondary events in patients following percutaneous coronary intervention: a time-trend analysis
Am Heart J
(2016) - et al.
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Hypertension
(2017) Systolic Blood Pressure Intervention Trial (SPRINT): Protocol Version 4.0
(2012)
Cited by (0)
Registration Number
ClinicalTrials.gov: NCT01206062.
Suggested Tweet: Prior CVD is a major risk for subsequent events in SPRINT, even when accounting for baseline Pooled Cohort Equation-predicted risk.
Funding: This work was sponsored by the Department of Medicine at the Larner College of Medicine. SPJ is sponsored by an NHLBI career development award (K23HL135273), Boston, MA.