How Effective is Intensive Blood Pressure Therapy on Heart Failure?

Treating people with a systolic blood pressure (SBP) of more than 120 mmHG reduces the risk of acute decompensated heart failure (ADHF), according to the results of a recent analysis of prespecified subgroups within the Systolic Blood Pressure Intervention Trial (SPRINT). The analysis was performed by Bharathi Upadhya, MD (photo), of the Wake Forest School of Medicine in Durham, North Carolina, and colleagues.

The SPRINT study population included 9361 participants who were enrolled between November 2010 and March 2013. The participants were diverse, including women, men, black people, nonblack people, those who had chronic kidney disease (CKD), prior cardiovascular disease (CVD), and people who fit into 3 categories of baseline SBP. The SPRINT trial showed that intensive blood pressure (BP) reduction reduced the risk of the primary outcome, which was a composite of multiple cardiovascular-related events, including ADHF.

In fact, “The risk of ADHF was reduced by 38% by intensive BP reduction in SPRINT,” the authors of the present analysis wrote.

Although intensive reduction of SBP clearly reduces the risk of ADHF, there is still uncertainty as to what the optimal BP target is to get the maximum benefit. The researchers undertook the current analysis to learn more about the risk of ADHF within particular subgroups as well as how intensive BP treatment impacts that risk, what the predictors of ADHF may be, and what the outcomes were for patients who developed ADHF during the SPRINT trial.

The BP intervention in the SPRINT trial was stopped “because of benefit in the intensive arm on the primary outcome,” the researchers wrote.

The standard arm of the study included 4683 participants; 103, or 2.2%, of them had ADHF events. However, the intensive arm included 4678 people, and only 65, or 1.4%, had ADHF events, which is a risk reduction of 37%.

Overall, the researchers reported, “ADHF was one of the most frequent outcomes in the SPRINT trial, which was terminated early because of a 25% reduction in the primary outcome, a composite of cardiovascular events, including ADHF.”

The current analysis extended beyond SPRINT shows that the benefit from intensive treatment occurred as early as the 6-month follow-up and continued to improve with each follow-up thereafter. The benefit was similar across all of the subgroups included in the analysis. But, those participants who did develop ADHF had an increased risk of subsequent cardiovascular events and death, highlighting the need for early and intensive intervention.

Previous studies had clearly shown the benefit of reducing SBP to the 140- mmHg to 145 mmHg range; however, the current analysis confirms that targeting an SBP of more than 120 mmHg further reduces risk.

The researchers concluded, “These findings highlight the importance of strategies aimed at the prevention of ADHF, especially ADHF.”

The complete analysis, “Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial,” can be found in the journal Circulation: Heart Failure.