Intensive BP control might harm smokers: secondary analysis of SPRINT

  • Scarpa J & al.
  • JAMA Netw Open
  • 1 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • Secondary SPRINT data analysis, 9361 participants.
  • Outcome: composite of cardiovascular events.
  • Funding: NIH, National Science Foundation.

Limitations

  • Some limitations of the forest-based analysis they used.
  • Cutoff of 144 mmHg is not a “clinically meaningful construct.”

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