Abstract
Purpose
The objective of this study was to determine individual and joint effects of pulse
pressure and blood pressure treatment intensity on serious adverse events in the Systolic
Blood Pressure Intervention Trial.
Methods
Pulse pressure was calculated by subtracting diastolic blood pressure from systolic
blood pressure. Blood pressure treatment intensity goal was ≤140 mm Hg in the control arm and ≤120 mm Hg in the intensive arm. The primary outcome was a 5-point composite of hypotension,
syncope, electrolyte abnormalities, acute renal insufficiency, or injurious falls.
Results
In 9361 trial participants, the incident rate for the primary outcome per 1000 person-years
increased with higher pulse pressure category: ≤49 mmHg: 20.4 (17.2-24.1), 50-59 mmHg:
24.5 (21.3-28.2), 60-69 mmHg: 31.7 (27.7-36.2), ≥70 mmHg: 44.6 (39.8-49.9; Ptrend < .0001; hazard ratio [HR] of pulse pressure [every 10 mm Hg] 1.23; 95% confidence interval [CI], 1.18-1.28). The intensive treatment arm
had a higher incidence rate of serious adverse events than the control arm (34.2,
95% CI, 31.2-37.3, vs 26.0, 95% CI, 23.4-28.8, P = .0001; HR 1.32; 95% CI, 1.15-1.51). The combined effect was not significant in
the relative risk scale (HR 0.97, Pinteraction = .48) but was significant in the risk difference scale (P = .027), contributing 2.5 additional serious adverse events per 1000 person-years
for every 10 mm Hg increase in pulse pressure in excess of the individual effects of pulse pressure
and treatment intensity.
Conclusions
Wider pulse pressure and intensive blood pressure treatment were individually associated
with the composite adverse event outcome. A modest effect modification of pulse pressure
and treatment intensity led to additional adverse events when both were present. Clinicians
should use caution when treating older patients with elevated pulse pressure to an
intensive blood pressure treatment target.
KEYWORDS
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Article info
Publication history
Published online: June 22, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript. AK had full access to all study data and takes complete responsibility for the integrity of the data and the accuracy of the statistical analysis. AK, DHK, DEF, MSM, KPA, and MWR developed the study concept and design and supervised the study. AK performed the statistical analysis. CEM, and DHK reviewed the statistical analysis. AK wrote the initial draft of the manuscript. All authors interpreted the data and approved the final manuscript.
Identification
Copyright
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