Clinical Outcomes by Race and Ethnicity in the Systolic Blood Pressure Intervention Trial (SPRINT): A Randomized Clinical Trial.

Autor:	Still CH; Frances Payne Bolton School of Nursing, Case Western Reserve University, USA., Rodriguez CJ; Wake Forest School of Medicine/Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, USA., Wright JT Jr; School of Medicine, Case Western Reserve University, USA.; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, USA., Craven TE; Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, USA., Bress AP; Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, USA., Chertow GM; Stanford University School of Medicine, Division of Nephrology, USA., Whelton PK; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA., Whittle JC; Department of Medicine, Medical College of Wisconsin, Milwaukee and Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, USA., Freedman BI; Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, USA., Johnson KC; Department of Preventive Medicine, University of Tennessee Health Science Center, USA., Foy CG; Department Social Sciences and Health Policy, School of Medicine, Wake Forest University, USA., He J; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, USA., Kostis JB; Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, USA., Lash JP; Department of Medicine, University of Illinois Chicago, USA., Pedley CF; Wake Forest Baptist Health, USA., Pisoni R; Department of Medicine, Medical University of South Carolina, USA., Powell JR; Division of General Internal Medicine, Brody School of Medicine, East Carolina University, USA., Wall BM; Memphis Veterans Affairs Medical Center, USA.
Jazyk:	angličtina
Zdroj:	American journal of hypertension [Am J Hypertens] 2017 Dec 08; Vol. 31 (1), pp. 97-107.
DOI:	10.1093/ajh/hpx138
Abstrakt:	Background: The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups. Methods: We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death. Results: Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57-0.86), 0.71 (0.51-0.98), 0.62 (0.33-1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29-0.81), 0.77 (0.37-1.57), and 0.17 (0.01-1.08). All-cause mortality HRs were 0.61 (0.47-0.80), 0.92 (0.63-1.35), and 1.58 (0.73-3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons. Conclusion: Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications. Clinical Trials Registration: Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062. (© The Author 2017. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.)
Databáze:	MEDLINE
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