Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES Journal Article

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Authors: Bress, A. P.; Kramer, H; Khatib, R.; Beddhu, S.; Cheung, A. K.; Hess, R.; Bansal, V. K.; Cao, G; Yee, J.; Moran, A. E.; Durazo-Arvizu, R. A.; Muntner, P; Cooper, R. S.
Article Title: Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES
Abstract: Background -The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a 27% reduction in all-cause mortality with a systolic blood-pressure (SBP) goal of /= 50 years, SBP of 130-180 mmHg (depending on the number of antihypertensive medications being taken), and high CVD risk. Exclusion criteria were diabetes, history of stroke, >1 gram of proteinuria, heart failure, estimated glomerular filtration rate 20 ml/min/1.73m2, or dialysis. Annual mortality rates were calculated by dividing the Kaplan-Meier 5-year mortality by 5. Hazard ratios for all-cause mortality and heart failure and absolute risks for SAEs in SPRINT were used to estimate the number of potential deaths and heart failure cases prevented and SAEs incurred with intensive SBP treatment. Results -The mean age was 68.6 years and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.20% (95%CI 1.91%-2.48%) and intensive SBP treatment was projected to prevent about 107,500 deaths per year (95%CI 93,300-121,200) and give rise to 56,100 (95%CI 50,800-61,400) episodes of hypotension, 34,400 (95%CI 31,200-37,600) episodes of syncope, 43,400 (95%CI 39,400-47,500) serious electrolyte disorders, and 88,700 (95%CI 80,400-97,000) cases of acute kidney injury per year. The analysis of extremes approach indicated that the range of estimated lower and upper bound number of deaths prevented per year with intensive SBP control was 34,600 to 179,600. Intensive SBP control was projected to prevent 46,100 (95%CI 41,800-50,400) cases of heart failure annually. Conclusions -If fully implemented in eligible U.S. adults, intensive SBP treatment could prevent about 107,500 deaths per year. A consequence of this treatment strategy, however, could be an increase in SAEs.
Journal Title: Circulation
ISSN: 1524-4539; 0009-7322
Publisher: Unknown  
Journal Place: United States
Date Published: 2017
Language: eng
DOI/URL:

CIRCULATIONAHA.116.025322
Notes: LR: 20170214; JID: 0147763; OTO: NOTNLM; 2017/01/25 [accepted]; 2016/09/02 [received]; 2017/01/06 [revised]; aheadofprint