Effects of Intensive Blood Pressure Lowering Treatment in Reducing Risk of Cardiovascular Events - ESPRIT
Contribution To Literature:
The ESPRIT trial showed that intensive blood pressure control improves outcomes.
Description:
The goal of the trial was to evaluate intensive blood pressure (BP) control (systolic BP [SBP] <120 mm Hg) compared with standard BP control (SBP <140 mm Hg) among patients with hypertension.
Study Design
- Randomized
- Parallel
- Blinded
Patients with hypertension were randomized to target SBP <120 mm Hg (n = 5,624) vs. target SBP <140 mm Hg (n = 5,631).
- Total number of enrollees: 11,255
- Duration of follow-up: 3.4 years
- Mean patient age: 65 years
- Percentage female: 41%
Inclusion criteria:
- Patients ≥50 years of age
- SBP 130-180 mm Hg
- Increased cardiovascular risk, defined as established cardiovascular disease or ≥2 cardiovascular risk factors
Exclusion criteria:
- Secondary cause of hypertension
- One-minute standing SBP <110 mm Hg
- Left ventricular ejection fraction <35%
- Estimated glomerular filtration rate <45 mL/min/1.73 m2
Other salient features/characteristics:
- Baseline BP: 147/83 mm Hg
- Diabetes: 39%
- Stroke: 27%
Principal Findings:
The primary outcome, cardiovascular death, myocardial infarction, stroke, coronary revascularization, noncoronary revascularization, or hospitalization for heart failure occurred in 3.2% in the SBP <120 mm Hg group vs. 3.6% in the <140 mm Hg group (p = 0.03). The results were the same in tested subgroups (history of stroke or diabetes).
Secondary outcomes:
- Cardiovascular death: 0.3% in the SBP <120 mm Hg group vs. 0.5% in the SBP <140 mm Hg group (p < 0.05)
- Stroke: 1.5% in the SBP <120 mm Hg group vs. 1.7% in the SBP <140 mm Hg group (p < 0.05)
- Syncope: 0.4% in the SBP <120 mm Hg group vs. 0.1% in the SBP <140 mm Hg (p < 0.05)
Interpretation:
Among Asian patients with hypertension and a large proportion of diabetes and stroke, intensive BP control improves outcomes compared with standard control. Target SBP <120 mm Hg reduced major adverse cardiac events compared with target SBP <140 mm Hg. Intensive BP control was associated with an absolute risk reduction of major adverse events of 0.4%. Intensive BP control was associated with an increased risk of syncope. The results of this trial are in line with the SPRINT trial, which enrolled <2% Asians and excluded subjects with diabetes or stroke.
References:
Presented by Dr. Jing Li at the American Heart Association Scientific Sessions, Philadelphia, PA, November 13, 2023.
Clinical Topics: Prevention, Hypertension, Vascular Medicine
Keywords: AHA23, Antihypertensive Agents, Hypertension
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