Page 9 - hypertension_newsletter7

REFLECTIONS
Hypertension
Hypertension Global Newsletter #7 2024

The authors conclude that targeting an SBP <130 mmHg
significantly reduces major CVD and all-cause mortality CLINICAL PEARLS FROM THE FACULTY Hypertension
compared with a SBP ≥130 mmHg target. Additionally, they
suggest that a target of <120 mmHg could be beneficial, but it
was based on pooling information from fewer RCTs and may
require further research.

WATCH
COMMENTARY FROM DR. FIKRLE
CLICK HERE DISCUSSING THE CLINICAL
FOR THE LINK TO FULL ARTICLE RELEVANCE OF THE ARTICLE.

Lowering systolic blood pressure to less than 120 mmHg versus less than 140
mmHg in patients with high cardiovascular risk with and without diabetes or

previous stroke: An open-label, blinded-outcome, randomised trial.
Liu J, et al. ESPRIT Collaborative Group. Lancet. 2024 Jul 20;404(10449):245-255.

Lowering BP is one of the most effective treatments to prevent After randomisation, both groups achieved sustained blood
CV events. However, it is not clear whether an intensive target pressure reduction. Throughout the follow-up (except the first
of SBP <120 mmHg is better than the standard treatment three months for titration), the mean systolic blood pressure
target of <140 mmHg, especially in patients with high CVD was 119.1 mmHg (SD 11.1) in the intensive treatment group
risk, with or without diabetes or previous stroke. and 134.8 mmHg (SD 10.5) in the standard treatment group.

While the original SPRINT trial demonstrated that targeting a During a median of 3.4 years of follow-up, the primary
SBP <120 mmHg was more effective in reducing the risk of outcome occurred in 9.7% of the participants in the intensive
major vascular events than <140 mmHg in patients with high treatment group and 11.1% in the standard treatment group
CV risk and without diabetes or stroke, several other trials (p=0.029). In addition, secondary outcomes of significance
focused on particular patient groups, such as ACCORD in included major vascular events without revascularisation
patients with diabetes and RESPECT in those with a history of (7.4% in the intensive treatment group vs. 8.8% in the
stroke, obtained non-significant results.
SBP in the standard and intensive treatment groups over the course
The ESPRIT (Effects of Intensive Systolic Blood Pressure of the trial
Lowering Treatment in Reducing Risk of Vascular Events)
trial was a multicentre, open-label, blinded-outcome RCT
conducted at 116 hospitals or community medical centres in
China. The trial included 11,255 patients aged ≥50 years with
SBP 130–180 mmHg and high CVD risk (i.e., established
CVD or ≥2 major CVD risk factors) who were assigned to
intensive treatment targeting office SBP <120 mmHg or
standard treatment targeting <140 mmHg. Approximately
39% of patients were diabetic and ~27% had previous stroke
at baseline. The mean SBP at baseline was ~147 mmHg for
both the intensive and standard treatment groups. The primary
endpoint was a composite of MI, revascularisation (coronary or
non-coronary), hospitalisation, or emergency room visit for HF,
stroke, or CV death.

TABLE OF CONTENTS