Intensive BP Control Lengthens Life: SPRINT Analysis
This is “another data point to share with patients when discussing whether their BP should be better managed,” a researcher says.
Adults aged 50 and older who have a high cardiovascular risk can expect an additional 6 months to 3 years of life when they aim for more-intensive blood pressure goals, a secondary analysis of the SPRINT trial suggests.
Estimated gains diminished with age but were still seen even for patients starting more-intensive treatment at age 85, according to a brief report by researchers led by Muthiah Vaduganathan, MD (Brigham and Women’s Hospital, Boston, MA).
“These estimates may be optimistic, especially if patients are less adherent with blood pressure-lowering or if achieved blood pressures are not . . . what was seen in the trial,” Vaduganathan told TCTMD. “However, I think that this does give clinicians another data point to share with patients in discussing whether their blood pressure should be better managed.”
The findings were published online recently in JAMA Cardiology.
In 2015, the 9,361-patient SPRINT trial showed that treating to a systolic BP goal of less than 120 mm Hg versus less than 140 mm Hg reduced cardiovascular events and all-cause mortality among nondiabetic adults with high cardiovascular risk, shifting guideline recommendations toward lower goals. A previous analysis showed that during the trial, intensive BP-lowering would be expected to prolong life by about 13 days compared with standard management.
But Vaduganathan and his colleagues wanted to explore the potential longer-term survival benefits. “As this information is becoming integrated into clinical practice and being communicated, we felt that reframing the SPRINT results in a way that’s more easily communicated to patients and clinicians would be worthwhile,” Vaduganathan said.
To do so, the investigators used previously validated actuarial methods to estimate gains in life span with intensive versus standard BP control started at various ages between 50 and 85. For the analysis, it was assumed that treatment effects seen during the trial would be maintained over time.
Estimated years of remaining life were numerically higher with intensive versus standard treatment at every age, although the between-group differences shrank with age. At 50, estimated residual survival was 37.3 years in the intensive arm and 34.4 years in the standard arm (P = 0.008). Residual life span was 1.1 year greater with intensive treatment goals at age 65 and 0.8 years greater at age 80.
“Given concerning declines in US life expectancy for the last 3 years, these analyses help strengthen the public health message that population-wide BP control remains a critical strategy to improve life expectancy in the United States,” the authors say. “Our analyses reaffirm the original SPRINT trial results and present them in [an] alternative format that can be easily communicated to clinicians, patients, and the public at large.”
They acknowledge some limitations of this type of study, noting that it did not take into account nonadherence, adverse events, or long-term variation in achieved systolic BP levels, all of which would affect expected survival benefits.
Nevertheless, commented D. Edmund Anstey, MD (NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), “it reaffirms the importance of blood pressure control and the idea that tighter blood pressure control can improve long-term health outcomes.”
Moreover, he agreed that the findings can be used to improve discussions between patients and their doctors.
“It’s not just challenging to predict outcomes but also to accurately communicate that information to patients such that they and their providers can have shared decisions about treatment strategies,” Anstey told TCTMD. “So I think that this manuscript can help improve that communication, and that’s sort of the main advantage of the study. It provides a novel way to explain the results of SPRINT to patients so that patients and providers can better understand the risks and benefits of long-term treatment.”
Though the estimated impact of intensive treatment on residual life span might be a bit rosy due to the limitations noted by the investigators, the study “lets us know under our best-case scenarios what could we expect and what could we hope for,” Anstey added.
Vaduganathan M, Claggett BL, Juraschek SP, Solomon SD. Assessment of long-term benefit of intensive blood pressure control on residual life span: secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). JAMA Cardiol. 2020;Epub ahead of print.
- Vaduganathan reports being supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst and serving on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa.
- Anstey reports no relevant conflicts of interest.