Research highlights:
- A three-year trial showed that intensive treatment with antihypertensive drugs to lower peak systolic blood pressure to below 120 mm Hg reduced cardiovascular disease events in people at high risk for cardiovascular disease compared to standard treatment with antihypertensive drugs. decreased by 12% compared to The goal is less than 140mmHg.
- This effect was consistent regardless of participants’ diabetes status (type 1, type 2, or none) and history of stroke.
Embargoed until Monday, November 13, 2023 at 8:00 a.m. ET
PHILADELPHIA, November 13, 2023 — Three-year intensive intervention to lower systolic blood pressure below 120 mmHg prevents death, heart attack, stroke, and other cardiovascular events in adults at high risk for cardiovascular disease compared to the standard treatment goal of less than 140 mm Hg, according to the latest science presented today at the American Heart Association. Academic Session 2023. The conference, to be held in Philadelphia from November 11-13, is the premier global gathering to exchange updates on the latest scientific advances, research, and evidence-based clinical practice in cardiovascular science. .
“Our study shows that in hypertensive patients with high cardiovascular risk and normal or mildly impaired renal function, regardless of diabetes status (type 1, type 2, or no diabetes) or history of diabetes, systolic “We provide evidence to support targeting blood pressure below 120 mm Hg in stroke.” Ta.
Researchers aimed to evaluate the effects of intensive blood pressure lowering strategies on the incidence of major cardiovascular events such as heart attack, stroke, cardiovascular death, revascularization, and cardiac hospitalizations and emergency department visits. A multicenter randomized controlled trial was conducted. Failure in participants with increased cardiovascular risk.
Participants in the ESPRIT trial were randomly assigned to receive intensive blood pressure treatment to achieve a systolic blood pressure of less than 120 mmHg or standard treatment to achieve a target reading of less than 140 mmHg over three years. Antihypertensive drugs were prescribed to lower blood pressure in both groups. Patients in the intensive care group received multiple classes of antihypertensive drugs and higher doses of antihypertensive drugs compared to the usual care group. Safety between treatment groups was assessed by comparing serious adverse events between participants.
Researchers found that after two years, participants in the intensive treatment group had significantly better outcomes than those who received standard treatment. Compared to standard care, intensive treatment strategies prevented:
- 12% of heart attacks, strokes, revascularizations, deaths from cardiovascular disease, and hospitalizations or emergency department visits for heart failure.
- 39% of deaths were due to cardiovascular disease.and
- 21% of deaths are due to any cause.
- There were no significant differences in serious adverse events such as hypotension, electrolyte abnormalities, fall trauma, acute kidney injury, or renal failure.
Syncope is one of the serious adverse events used to assess safety. Syncope occurred at a rate of 0.4% per year in the intensive treatment group and 0.1% in the standard treatment group. This means that for every 1000 patients treated in intensive care for 3 years, 3 patients will experience a serious adverse event of syncope, and 14 additional major vascular events and 8 deaths will be prevented. Li pointed out that this means that
“These results provide evidence that intensive hypertension treatment, focused on reducing systolic blood pressure below 120 mmHg, is beneficial and safe for people with hypertension and increased cardiovascular risk factors. ,” Lee said. “Implementation of this intensive care strategy for high-risk adults has the potential to save more lives and reduce the public health burden of heart disease around the world.”
Research details and background:
- The ESPRIT trial included 11,255 Chinese adults. Participants had a baseline systolic blood pressure measurement of 130 to 180 mmHg and had cardiovascular disease or at least two major risk factors for cardiovascular disease.
- The average age of participants was 64.6 years. According to the national ID card, 41.3% were identified as female and 58.7% as male.
- Approximately 27% of study participants had a history of stroke. Approximately 29% had previous coronary heart disease. and about 39% had type 1 or type 2 diabetes.
- The primary outcome of this trial was the composite outcome of heart attack, coronary or noncoronary revascularization, hospitalization/emergency department visit for heart failure, stroke, or death from CV. Secondary outcomes included CV outcomes, renal outcomes, and cognitive outcomes.
Limitations of the study include that the intervention lasted only 3 years, whereas the cardiovascular benefits of the intensive intervention appeared after 2 years, meaning that the relatively short study period meant that the benefits were not apparent. That means they may be underestimating, Lee said. Additionally, this study was conducted in China, so the results may not be generalizable to other races or ethnicities or people living in other countries. However, Lee also noted that the results are consistent with similar studies in people of other races and ethnicities.
Future research will include investigating the long-term effects of intensive intervention strategies over a follow-up period.
The 2017 ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults classify stage 1 hypertension as having upper and lower values of 130/80 mm Hg or higher and stage 2 hypertension as It is classified as having upper and lower numerical values. Bottom reading is 140/90 mm Hg or higher. If left undetected or uncontrolled, high blood pressure can increase the risk of cardiovascular events such as heart attack, stroke, heart failure, kidney disease or failure, and peripheral artery disease.
Co-authors, disclosures, and funding sources are listed in the abstract.
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