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SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk
The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research cent...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415523/ https://www.ncbi.nlm.nih.gov/pubmed/34455813 http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17579 |
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author | Laurent, Stephane Chatellier, Gilles Azizi, Michel Calvet, David Choukroun, Gabriel Danchin, Nicolas Delsart, Pascal Girerd, Xavier Gosse, Philippe Khettab, Hakim London, Gerard Mourad, Jean-Jacques Pannier, Bruno Pereira, Helena Stephan, Dominique Valensi, Paul Cunha, Pedro Narkiewicz, Krzysztof Bruno, Rosa-Maria Boutouyrie, Pierre |
author_facet | Laurent, Stephane Chatellier, Gilles Azizi, Michel Calvet, David Choukroun, Gabriel Danchin, Nicolas Delsart, Pascal Girerd, Xavier Gosse, Philippe Khettab, Hakim London, Gerard Mourad, Jean-Jacques Pannier, Bruno Pereira, Helena Stephan, Dominique Valensi, Paul Cunha, Pedro Narkiewicz, Krzysztof Bruno, Rosa-Maria Boutouyrie, Pierre |
author_sort | Laurent, Stephane |
collection | PubMed |
description | The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P<0.001 and P<0.01, respectively), and PWV increased less (P=0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines. |
format | Online Article Text |
id | pubmed-8415523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-84155232021-09-03 SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk Laurent, Stephane Chatellier, Gilles Azizi, Michel Calvet, David Choukroun, Gabriel Danchin, Nicolas Delsart, Pascal Girerd, Xavier Gosse, Philippe Khettab, Hakim London, Gerard Mourad, Jean-Jacques Pannier, Bruno Pereira, Helena Stephan, Dominique Valensi, Paul Cunha, Pedro Narkiewicz, Krzysztof Bruno, Rosa-Maria Boutouyrie, Pierre Hypertension Original Articles The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P<0.001 and P<0.01, respectively), and PWV increased less (P=0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines. Lippincott Williams & Wilkins 2021-08-30 2021-10 /pmc/articles/PMC8415523/ /pubmed/34455813 http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17579 Text en © 2021 The Authors. https://creativecommons.org/licenses/by-nc-nd/4.0/Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. |
spellingShingle | Original Articles Laurent, Stephane Chatellier, Gilles Azizi, Michel Calvet, David Choukroun, Gabriel Danchin, Nicolas Delsart, Pascal Girerd, Xavier Gosse, Philippe Khettab, Hakim London, Gerard Mourad, Jean-Jacques Pannier, Bruno Pereira, Helena Stephan, Dominique Valensi, Paul Cunha, Pedro Narkiewicz, Krzysztof Bruno, Rosa-Maria Boutouyrie, Pierre SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title | SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title_full | SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title_fullStr | SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title_full_unstemmed | SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title_short | SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk |
title_sort | sparte study: normalization of arterial stiffness and cardiovascular events in patients with hypertension at medium to very high risk |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415523/ https://www.ncbi.nlm.nih.gov/pubmed/34455813 http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17579 |
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