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Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT)
To investigate the optimal blood pressure (BP) in patients with coronary artery disease (CAD), we conducted subgroup analysis using SPRINT data. The study sample included 1206 participants with CAD (of whom 692 underwent coronary revascularization) and 8127 participants without CAD. Participants wer...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group UK
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8766284/ https://www.ncbi.nlm.nih.gov/pubmed/33589758 http://dx.doi.org/10.1038/s41371-021-00494-8 |
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author | Zang, Jiabin Liang, Jianwen Zhuang, Xiaodong Zhang, Shaozhao Liao, Xinxue Wu, Guifu |
author_facet | Zang, Jiabin Liang, Jianwen Zhuang, Xiaodong Zhang, Shaozhao Liao, Xinxue Wu, Guifu |
author_sort | Zang, Jiabin |
collection | PubMed |
description | To investigate the optimal blood pressure (BP) in patients with coronary artery disease (CAD), we conducted subgroup analysis using SPRINT data. The study sample included 1206 participants with CAD (of whom 692 underwent coronary revascularization) and 8127 participants without CAD. Participants were randomized into two groups (systolic BP target of 140 mm Hg vs. 120 mm Hg). The primary outcome was a composite of cardiovascular events. After a median follow-up of 3.9 years, the hazard ratios (HRs) for the primary outcome were 0.65 (95% confidence interval (CI) 0.53–0.79) and 1.05 (95% CI 0.76–1.46) among those in the non-CAD and CAD subgroups, respectively (P value for interaction 0.02). Intensive BP treatment was a protective factor for all-cause death (HR 0.60, 95% CI 0.37–0.96) in the CAD subgroup, compared with standard BP treatment. The HRs (95% CI) for stroke were 3.57 (1.17–10.85) and 1.03 (0.29–3.62) among those in the coronary revascularization and non-revascularization subgroups, respectively (P value for interaction 0.13). For safety events, intensive BP treatment increased the risk of hypotension (HR 2.00, 95% CI 1.06–3.79) and electrolyte abnormalities (HR 2.38, 95% CI 1.25–4.56) in the CAD subgroup, while the risk of serious adverse events did not increase (HR 1.03, 95% CI 0.88–1.20). These results suggest that positive benefits from intensive BP treatment might be attenuated in patients with CAD who are under better secondary prevention. The risk of stroke might increase at the systolic BP target of 120 mm Hg in case of coronary revascularization, although the confidence interval was wide. |
format | Online Article Text |
id | pubmed-8766284 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-87662842022-02-04 Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) Zang, Jiabin Liang, Jianwen Zhuang, Xiaodong Zhang, Shaozhao Liao, Xinxue Wu, Guifu J Hum Hypertens Article To investigate the optimal blood pressure (BP) in patients with coronary artery disease (CAD), we conducted subgroup analysis using SPRINT data. The study sample included 1206 participants with CAD (of whom 692 underwent coronary revascularization) and 8127 participants without CAD. Participants were randomized into two groups (systolic BP target of 140 mm Hg vs. 120 mm Hg). The primary outcome was a composite of cardiovascular events. After a median follow-up of 3.9 years, the hazard ratios (HRs) for the primary outcome were 0.65 (95% confidence interval (CI) 0.53–0.79) and 1.05 (95% CI 0.76–1.46) among those in the non-CAD and CAD subgroups, respectively (P value for interaction 0.02). Intensive BP treatment was a protective factor for all-cause death (HR 0.60, 95% CI 0.37–0.96) in the CAD subgroup, compared with standard BP treatment. The HRs (95% CI) for stroke were 3.57 (1.17–10.85) and 1.03 (0.29–3.62) among those in the coronary revascularization and non-revascularization subgroups, respectively (P value for interaction 0.13). For safety events, intensive BP treatment increased the risk of hypotension (HR 2.00, 95% CI 1.06–3.79) and electrolyte abnormalities (HR 2.38, 95% CI 1.25–4.56) in the CAD subgroup, while the risk of serious adverse events did not increase (HR 1.03, 95% CI 0.88–1.20). These results suggest that positive benefits from intensive BP treatment might be attenuated in patients with CAD who are under better secondary prevention. The risk of stroke might increase at the systolic BP target of 120 mm Hg in case of coronary revascularization, although the confidence interval was wide. Nature Publishing Group UK 2021-02-15 2022 /pmc/articles/PMC8766284/ /pubmed/33589758 http://dx.doi.org/10.1038/s41371-021-00494-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Zang, Jiabin Liang, Jianwen Zhuang, Xiaodong Zhang, Shaozhao Liao, Xinxue Wu, Guifu Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title | Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title_full | Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title_fullStr | Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title_full_unstemmed | Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title_short | Intensive blood pressure treatment in coronary artery disease: implications from the Systolic Blood Pressure Intervention Trial (SPRINT) |
title_sort | intensive blood pressure treatment in coronary artery disease: implications from the systolic blood pressure intervention trial (sprint) |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8766284/ https://www.ncbi.nlm.nih.gov/pubmed/33589758 http://dx.doi.org/10.1038/s41371-021-00494-8 |
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