Resistant hypertension: intensive treatment reduces MACE

  • Tsujimoto T & al.
  • Hypertension
  • 24 Dec 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For resistant hypertension, intensive BP treatment reduces risk for major adverse cardiovascular events (MACE), with tradeoff of more syncope, hyponatremia.
  • Patient population from SPRINT study.

Why this matters

  • Evidence supporting aggressive BP targeting in resistant hypertension is limited, say the authors.
  • This study looked at targeting

Key results

  • Vs standard target, MACE risk was reduced with intensive targeting in resistant hypertension group:
    • HR, 0.62 (95% CI, 0.40-0.96; P=.03). 
  • Vs standard target, death risk was also reduced with intensive targeting:
    • All-cause death: HR, 0.60 (95% CI, 0.38-0.97; P=.03);
    • Cardiovascular death: HR, 0.34 (95% CI, 0.15-0.81; P=.01).
  • These risk reductions were steeper than for those without resistant hypertension.
  • Using 2008 vs 2018 American Heart Association resistant hypertension definitions yielded similar outcomes.
  • Patients with resistant hypertension ≥140/90 mmHg and taking 3+ antihypertensives also had similar risk reductions with intensive targeting.
  • Syncope, hyponatremia risks elevated with intensive targeting.

Study design

  • Secondary analysis of SPRINT (Systolic Blood Pressure Intervention Trial), including 1397 with resistant hypertension (n=705, standard target; n=692, intensive target), 7698 without.
  • Funding: Japan Society for the Promotion of Science.

Limitations

  • Low statistical power. 

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