Author + information
- Michael A. Weber,
- George Bakris,
- Allen Hester,
- Matthew Weir,
- Tsushung Hua,
- Dion Zappe,
- Bjorn Dahlof,
- Eric Velazquez,
- Bertram Pitt and
- Kenneth Jamerson
Randomized controlled trials (RCT) in hypertension demonstrate cardiovascular (CV) benefits when systolic blood pressures (BP) are reduced from higher values to <160 mmHg. The value of lower targets has not been fully defined, although major guidelines recommend achieving systolic BPs of < 140 mmHg.
Based on a pre-specified plan to explore relationships between clinical outcomes and systolic BPs, the pooled cohort of high risk hypertensive patients (N=10,705) of the RCT, ACCOMPLISH, were divided into 4 strata of BP: > 140; 130 – <140; 120 – <130; and 110 – <120 mmHg. The primary endpoint was CV death or non-fatal myocardial infarction (MI) or stroke. Outcomes comparisons between the BP groups were by Cox regression.
Mean patient age was 68 and study duration was 35.7 months. The primary endpoint occurred in 171/3429 (5.0%) patients in the 10 mmHg range <140 and 179/2354 (7.6%) patients > 140 mmHg; hazard ratio (HR) = 0.62 (95% CI: 0.50, 0.77), P = 0.0001; similarly, CV death fell by 36% (P = 0.0147), total MI (fatal + non-fatal) by 37% (P = 0.0028), and stroke by 47% (P = 0.0002). CV event rates in the range <130 were not different from <140 mmHg. However, compared with < 130, stroke in the range < 120 mmHg was lower: HR= 0.60 (0.35, 1.01), P = 0.0529; but MI was higher: HR= 1.52 (1.00, 2.29), P = 0.0437; as were composite coronary events (MI or hospitalized angina or sudden death): HR= 1.63 (1.18, 2.24), P = 0.0023. The renal endpoint of a sustained >50% increase in serum creatinine was significantly lower in the <140 mmHg range than in any of the other higher or lower BP ranges.
In high risk hypertensive patients, major CV events are significantly lower in the <140 and <130 mmHg ranges than >140 mmHg. There are stroke benefits at <120 mmHg but they are offset by increased coronary events. Renal function is best protected in the 130-139 mmHg range.
North, Room 121
Sunday, March 10, 2013, 8:15 a.m.-8:30 a.m.
Session Title: Prevention: Blood Pressure – Hot Topics for 2013
Abstract Category: 25. Prevention: Hypertension
Presentation Number: 918-4
- 2013 American College of Cardiology Foundation