Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Intensive BP Treatment & Subsequent CVD Risk

J Am Coll Cardiol; ePub 2018 Mar 7; Phillips, et al

Individuals with lower baseline cardiovascular disease (CVD) risk had more harm than benefit from intensive treatment of hypertension, while those with higher risk had more benefit. This according to a study that examined the effect of baseline 10-year CVD risk on primary outcome events and all-cause serious adverse events (SAEs) in the Systolic Pressure Intervention Trial (SPRINT). Stratifying by quartiles of baseline 10-year CVD risk, Cox proportional hazards models were used to examine the associations of treatment group with primary outcomes events and SAEs. Researchers found:

  • Within each quartile, there was a lower rate of primary outcome vents in the intensive treatment group, with no differences in all-cause SAEs.
  • The number needed to treat to prevent primary outcomes decreased from 91 to 30 from the first to fourth quartiles.
  • The number need to harm for all-cause SAEs increased from 62 to 250.
  • There was significantly increasing benefit-to-harm ratio for the first, second, third, and fourth quartile, respectively.


Phillips R, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. [Published online ahead of print March 7, 2018]. J Am Coll Cardiol. doi:10.1016/j.jacc.2018.01.074.

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