Personalizing the Intensity of Blood Pressure Control

Abstract

2 Patel et al Personalizing Intensity of Blood Pressure Control predict clinical outcomes for individual patients and support personalized treatment recommendations. To better inform the decision between choosing an inten-sive or standard BP control strategy, we leveraged data from the SPRINT trial to develop risk prediction models for major adverse cardiovascular events (MACE) or death and any treat-ment-related SAEs, as a function of alternative BP strategies. Not only could these models better translate the SPRINT results into clinical practice by describing the range of benefits and risks with each BP treatment strategy across the population, they could also estimate the benefits and risks for individual patients and serve as tools for patient engagement and shared decision making. 4 Methods Study Cohort Details of the SPRINT study have been described. 2,5 Briefly, SPRINT was a multicenter, randomized trial comparing intensive (target systolic BP [SBP] <120 mm Hg) versus standard (target SBP <140 mm Hg) BP control strategies in 9361 patients aged ≥50 years with hypertension at high cardiovascular risk. High cardiovascular risk was defined as one or more of the following: clinical or subclinical cardiovascular disease, chronic kidney disease, 10-year risk of car-diovascular disease of ≥15% (per Framingham risk score), or age ≥75 years. Key exclusion criteria included a diagnosis of diabetes mellitus, prior stroke, systolic heart failure (ejection fraction <35%), or end-stage renal disease. All patients provided written informed consent for baseline and follow-up assessment, and the study was approved by institutional review boards at each participating site. The trial was stopped early, after a median follow-up of 3.26 years, based on statistically significant and clinically relevant benefits from inten-sive treatment.