Targeting the Efficacy of Intensive Blood Pressure Treatment in Hypertensive Patients ― An Exploratory Analysis of SPRINT ―

Abstract

Background: Hypertensive patients show highly heterogeneous treatment effects (HTEs) and cardiovascular prognosis, and not all benefit from intensive blood pressure treatment. Methods and Results: We used the causal forest model to identify potential HTEs of patients in the Systolic Blood Pressure Intervention Trial (SPRINT). Cox regression was performed to assess hazard ratios (HRs) for cardiovascular disease (CVD) outcomes and to compare the effects of intensive treatment among groups. The model revealed 3 representative covariates and patients were partitioned into 4 subgroups: Group 1 (baseline body mass index [BMI] ≤28.32kg/m2 and estimated glomerular filtration rate [eGFR] ≤69.53mL/min/1.73m2); Group 2 (baseline BMI ≤28.32kg/m2 and eGFR >69.53mL/min/1.73m2); Group 3 (baseline BMI >28.32kg/m2 and 10-year CVD risk ≤15.8%); Group 4 (baseline BMI >28.32kg/m2 and 10-year CVD risk >15.8%). Intensive treatment was shown to be beneficial only in Group 2 (HR 0.54, 95% confidence interval [CI] 0.35–0.82; P=0.004) and Group 4 (HR 0.69, 95% CI 0.52–0.91; P=0.009). Conclusions: Intensive treatment was effective for patients with high BMI and 10-year CVD risk, or low BMI and normal eGFR, but not for those with low BMI and eGFR, or high BMI and low 10-year CVD risk. Our study could facilitate the categorization of hypertensive patients, ensuring individualized therapy.