Bress AP, et al. – The physicians conducted this work to determine whether the impacts of intensive (<120 mmHg) compared with standard (<140 mmHg) systolic blood pressure (SBP) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial (SPRINT). In SPRINT, it was revealed that the beneficial effects of intensive systolic blood pressure treatment were similar among those with prediabetes and fasting normoglycemia.

Methods

• Researchers designed a post hoc analysis of SPRINT.
• They classified SPRINT participants by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose <100 mg/dL).
• The preliminary endpoint was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes.
• They applied cox regression to estimate hazard ratios for study outcomes with intensive compared with standard SBP treatment among those with prediabetes and normoglycemia.

Results

• For this study, participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively.
• After a median follow–up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (P value for interaction 0.30).
• The hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (P value for interaction 0.74) for all–cause mortality.
• They found similar impacts of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events for prediabetes and normoglycemia (all interaction P > 0.05).