- Intensive BP control to SPRINT targets in smokers with baseline systolic measures of >144 mmHg is linked to increased risk for cardiovascular events.
- Ad hoc secondary analysis of trial data identifies potentially adversely affected subgroup.
Why this matters
- Editorial: “This suggests a 3-way interaction with treatment.”
- Editorial notes that original trial finding showed nonsignificantly elevated event rate among smokers and nonsignificant treatment effect in those with higher systolic BP.
- In subset of smokers with baseline systolic BP >144 mmHg:
- 10.9% had events with intervention treatment vs 4.8% for standard treatment.
- HR, 10.6 (95% CI, 1.3-86.1; P=.03).
- Number needed to harm: 43.7 for 1 event in 3.3 years.
- They also had increased risk for acute kidney injury when treated to SPRINT targets:
- 10.0% for intervention treatment vs 3.2% with conventional.
- HR, 9.4 (95% CI, 1.2-77.3; P=.04).
- By comparison, HR was 1.6 (95% CI, 1.2-2.2; P=.005) for everyone else.
- Secondary SPRINT data analysis, 9361 participants.
- Outcome: composite of cardiovascular events.
- Funding: NIH, National Science Foundation.
- Some limitations of the forest-based analysis they used.
- Cutoff of 144 mmHg is not a “clinically meaningful construct.”