Wang S, et al. - Researchers wanted to find out whether stratification by cardiovascular disease (CVD) risk will identify hypertensive patients with a more favorable risk/benefit profile for intensive blood pressure (BP) lowering. Patient-level data was used from two trials (SPRINT and ACCORD) that tested intensive vs standard BP lowering. A simple risk prediction model consisting of age, urinary albumin/creatinine ratio (UACR), and clinical CVD history was developed and validated for its utility. This risk prediction model successfully identified a subset of hypertensive patients who derived a more favorable risk/benefit profile for intensive BP lowering.

Methods

• A decision-tree was developed using recursive partitioning modeling and a subset of patients at the extremes of major adverse cardiovascular event (MACE) rates from SPRINT.
• The model consisted of age≥74 years, UACR ≥34, and history of clinical CVD.
• Its predictive effects were validated in the remaining “intermediate” SPRINT subset (n=8,357).
• Its external validation was carried out in ACCORD (n=2,258).

Results

• In SPRINT and in ACCORD, it classified 48.6% and 55.3% of patients, respectively, as “high-risk.”
• In association with intensive BP lowering, relative to standard treatment, lower rates of MACE were reported in this high-risk population in both SPRINT cross-validation data (HR=0.66, 95% CI 0.52-0.85) and ACCORD (HR=0.67, 95% CI 0.50-0.90), but not in the remaining low-risk patients (SPRINT: HR=0.83, 95% CI 0.56-1.25; ACCORD: HR=1.09, 95% CI 0.64-1.83).
• With intensive BP lowering, no excess risk of serious adverse events was noted in the high-risk group.