{"id":6130,"date":"2019-07-19T06:43:48","date_gmt":"2019-07-19T13:43:48","guid":{"rendered":"https:\/\/amjmed.org\/?p=5900"},"modified":"2019-11-07T12:20:58","modified_gmt":"2019-11-07T19:20:58","slug":"5900-2","status":"publish","type":"post","link":"https:\/\/amjmed.org\/5900-2\/","title":{"rendered":"Body Mass Index, Intensive Blood Pressure Management, and Cardiovascular Events in the SPRINT Trial"},"content":{"rendered":"<figure id=\"attachment_5915\" aria-describedby=\"caption-attachment-5915\" style=\"width: 569px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2019\/07\/gr1-2.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\" wp-image-5915\" src=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2019\/07\/gr1-2.jpg?resize=569%2C662&#038;ssl=1\" alt=\"\" width=\"569\" height=\"662\" \/><\/a><figcaption id=\"caption-attachment-5915\" class=\"wp-caption-text\">The association between body mass index and efficacy and safety endpoints. The solid lines represent the incidence ratio (per 100 person-years) at each body mass index interval. The dashed lines represent the upper and lower bounds of the 95% confidence interval. The bars represent the distribution of body mass index values. The P values are for unadjusted trends.<\/figcaption><\/figure>\n<div class=\"content\">\n<section>\n<div class=\"content\">\n<p>It is unclear whether intensive blood pressure management is well-tolerated and affects risk uniformly across the body mass index (BMI) spectrum.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<div class=\"content\">\n<section>\n<h3 class=\"sectionTitle\" tabindex=\"0\">Methods<\/h3>\n<div class=\"content\">\n<p>The randomized, controlled Systolic Blood Pressure Intervention Trial (SPRINT) included 9361 individuals \u226550 years of age at high cardiovascular risk, without diabetes mellitus, with systolic blood pressure between 130 and 180 mmHg. Participants were randomized to intensive vs standard antihypertensive treatment and evaluated for the primary composite efficacy endpoint of acute coronary syndromes, stroke, heart failure, or cardiovascular death. The primary safety endpoint was serious adverse events. We used restricted cubic splines to determine the relationship between BMI, response to intensive blood pressure lowering, and clinical outcomes in SPRINT.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<div class=\"content\">\n<section>\n<h3 class=\"sectionTitle\" tabindex=\"0\">Results<\/h3>\n<div class=\"content\">\n<p>Body mass index could be calculated for 9284 (99.2%) individuals. Mean BMI was similar between the 2 treatment groups (intensive group 29.9\u00b15.8 kg\/m<sup>2<\/sup>\u00a0vs standard group 29.8\u00b1 5.7 kg\/m<sup>2<\/sup>;\u00a0<em>P<\/em>\u202f=\u202f0.39). Median follow-up was 3.3 years (range 0-4.8 years). Body mass index had a significant, J-shaped association with risk of all-cause mortality, stroke, and serious adverse events (<em>P<\/em>\u00a0&lt; .05 for all), but these were no longer significant after accounting for key clinical factors (<em>P<\/em>\u00a0&gt; .05 for all). Intensive blood pressure lowering reduced the primary efficacy endpoint and increased the primary safety endpoint compared with standard targets, consistently across the BMI spectrum (<em>P<\/em><sub>interaction<\/sub>\u00a0&gt; .05).<\/p>\n<\/div>\n<\/section>\n<\/div>\n<div class=\"content\">\n<section>\n<h3 class=\"sectionTitle\" tabindex=\"0\">Conclusion<\/h3>\n<div class=\"content\">\n<p>The overall efficacy and safety of intensive blood pressure lowering did not appear to be modified by baseline BMI among high-risk older adults.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<p>To read this article in its entirety please visit our\u00a0<a href=\"https:\/\/www.amjmed.com\/article\/S0002-9343(19)30133-0\/fulltext\">website<\/a>.<\/p>\n<p>-Christina Stolzenburg Oxlund, MD, PhD<sup>a<\/sup><sup>,<\/sup><sup>1<\/sup>,\u00a0Manan Pareek, MD, PhD<sup>b<\/sup><sup>,<\/sup><sup>1<\/sup>,\u00a0Benjamin Schnack Brandt Rasmussen, MD, PhD<sup>c<\/sup>,\u00a0Muthiah Vaduganathan, MD, MPH<sup>b<\/sup>,\u00a0Tor Biering-S\u00f8rensen, MD, MPH, PhD<sup>b<\/sup>,\u00a0Christina Byrne, MD, PhD<sup>d<\/sup>,\u00a0Zaid Almarzooq, MD<sup>b<\/sup>,\u00a0Michael Hecht Olsen, MD, PhD, DMSc<sup>e<\/sup>,\u00a0Deepak L. Bhatt, MD, MPH<sup>b<\/sup><sup>,<\/sup><\/p>\n<p>This article originally appeared in the <a href=\"https:\/\/www.amjmed.com\/issue\/S0002-9343(19)X0006-6\">July 2019<\/a> issue\u00a0of<em><strong>\u00a0The American Journal of Medicine.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It is unclear whether intensive blood pressure management is well-tolerated and affects risk uniformly across the body mass index (BMI) spectrum. Methods The randomized, controlled Systolic Blood Pressure Intervention Trial (SPRINT) included 9361 individuals \u226550 years of age at high cardiovascular risk, without diabetes mellitus, with systolic blood pressure between 130 and 180 mmHg. Participants [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":5915,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[29,30,381],"tags":[457,928,547],"class_list":{"0":"post-6130","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-blood-pressure","8":"category-bmi","9":"category-diet","10":"tag-blood-pressure-2","11":"tag-bmi","12":"tag-hypertension-2"},"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/6130","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/comments?post=6130"}],"version-history":[{"count":0,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/6130\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/media?parent=6130"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/categories?post=6130"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/tags?post=6130"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}