Intensive BP lowering offers similar benefits in prediabetes vs standard treatment

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Takeaway

  • The beneficial effects of intensive Systolic BP (SBP) treatment (<120 mmHg) vs standard SBP treatment (<140 mmHg) on the reduction of cardiovascular disease events and all-cause mortality were similar among those with prediabetes and fasting normoglycemia.

Why this matters

  • Given the inconsistent results of the overall Systolic Blood Pressure Intervention Trial (SPRINT) trial, the analysis of the effect of intensive BP treatment in high-risk patients with prediabetes vs normoglycemia is important.

Study design

  • 9361 SPRINT participants were categorized as prediabetic (baseline fasting serum glucose ≥ 100 mg/dL, n=3898) and normoglycemic (fasting serum glucose <100 mg/dL, n=5425).
  • Primary outcome was a composite of myocardial infarction, acute coronary syndrome.
  • Funding: SPRINT is funded by the National institutes of health.

Key results

  • Among those with prediabetes and normoglycemia, the HR for the primary outcome was 0.69 and 0.83, respectively (P for interaction .30) (median follow-up 3.26 y).
  • The HR with intensive SBP treatment for all-cause mortality was:

         — 0.77 (95% CI, 0.55-1.06) for prediabetes

         — 0.71 (95% CI 0.54, 0.94) for normoglycemia

  • For prediabetes and normoglycemia, the effects of intensive vs standard SBP treatment on prespecified renal outcomes and serious adverse events were similar (all interaction P>.05).

Limitations

  • Lack of data on HbA1c.