HypertensionSecondary analysis
The association of intensive blood pressure treatment and non-fatal cardiovascular or serious adverse events in older adults with mortality: mediation analysis in SPRINT
- Secondary analysis of the SPRINT randomised trial
- causal mediation analysis
Authors' conclusion
The current analytic techniques demonstrated that intensive BP treatment was associated with an attenuated mortality benefit when it was MACE-mediated and possibly harmful when it was SAE-mediated.
Study context
- Population
- Older adults in the Systolic Blood Pressure Intervention Trial
- Participants
- 9,361 adults
- Comparison
- Intensive vs standard blood pressure (BP) treatment
- Primary endpoint
- All-cause mortality (ACM)
Primary result
All-cause mortality
Odds ratio
0.75
95% CI 0.60–0.94
Intensive vs Standard
OR 0.75 (95% CI 0.60–0.94)
As reported in the abstract
- MACE-mediated effect on all-cause mortality (ACM) (attenuated)
- OR 0.96, 95% CI: 0.92-0.99
- SAE-mediated effect on ACM (increased)
- OR 1.03, 95% CI: 1.01-1.05
Secondary outcomes
CV and non-CV mortality
- Similar patterns for intensive BP treatment on CVM and non-CVM
Incidence of SAE, MACE and mortality (whole cohort)
- SAE incidence
- 13.7%
- MACE incidence
- 3.5%
- SAE vs MACE incidence
- 3.9-fold higher
- ACM cases
- 365 (3.9%)
- Non-CV mortality
- 2.81% (263/9361)
- CV mortality
- 1.09% (102/9361)
- Non-CVM vs CVM
- 2.6-fold higher
- SAE to MACE and non-CVM to CVM preponderance across all age groups, highest in ≥80-year group
Original publication
The association of intensive blood pressure treatment and non-fatal cardiovascular or serious adverse events in older adults with mortality: mediation analysis in SPRINT. Eur J Prev Cardiol. Published 25 April 2023. doi:10.1093/eurjpc/zwad132
Summarised from the published abstract; every number is checked against it