Clinical Edge

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

Effects of Pulse Pressure & BP Tx Intensity on AEs

Am J Med; ePub 2018 Jun 22; Krishnaswami, et al

In a study to determine individual and joint effects of pulse pressure and blood pressure (BP) treatment intensity on serious adverse events from the SPRINT trial, researchers found wider pulse pressure and intensive BP treatment individually were associated with the composite adverse event outcome. The primary outcome was a 5-point composite of hypotension, syncope, electrolyte abnormalities, acute renal insufficiency, or injurious falls. Among the details:

  • In 9,361 SPRINT participants, the incident rate for the primary outcome per 1,000 person-years increased with higher pulse pressure category ≤ 49: 20.4 (17.2-24.1), 50-59: 24.5 (21.3-28.2), 60-69: 31.7 (27.7-36.2), ≥ 70: 44.6 (39.8-49.9); hazard ratio (HR) of pulse pressure (every 10 mmHg) was 1.23, 95% CI: 1.18-1.28.
  • Intensive treatment arm had a higher incidence of serious adverse events than control arm (HR, 1.32).
  • The combined effect was not significant in the relative risk scale, but was in the risk difference scale, contributing 2.5 additional serious adverse events per 1,000 person-years for every 10 mmHg increase in pulse pressure in excess of the individual effects of pulse pressure and treatment intensity.

Citation:

Krishnaswami A, Kim DH, McCulloch CE, et al. Individual and joint effects of pulse pressure and blood pressure treatment intensity of serious adverse events in the SPRINT Trial. [Published online ahead of print June 22, 2018]. Am J Med. doi:10.1016/j.amjmed.2018.05.027.