Introduction: Hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. Risk factors for the prevalence of hypertension include modifiable and non-modifiable risk factors. Modifiable risk factors include having unhealthy diets, processed and junk foods, less intake of fruits and vegetables, consumption of tobacco and alcohol, physical inactivity which lead to overweight or obesity.

Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease. ^1,2

Method: 9361 participants who had increased risk for cardiovascular disease , were non diabetic, and had no previous stroke and had no intensive treatment target (systolic blood pressure, <120 mm Hg) or a standard treatment target (systolic blood pressure, <140 mm Hg) were included in the study. The Patients were randomly divided as standard treatment group (targeting the systolic pressure to <140 mmHg) or an intensive treatment group (targeting the systolic pressure to <120 mmHg); for both the groups, the diastolic pressure goal was <90 mm of Hg. ³

Antihypertensive therapy comprising of angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB; but not both), a long-acting dihydropyridine calcium channel blocker, or a thiazide-like diuretic or a combination of these drugs were administered to attain the targeted blood pressure. Medications were actively withdrawn as per the requirement. Additional data of different events were analyzed till the end of the trial period and also post-trial from the follow-ups.⁴

Result: It was observed that the Intensive treatment significantly reduced the rate of primary outcome, a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure and cardiovascular death as compared to the standard-treatment group during the trial period. Intensive treatment significantly reduced mortality rate (3.5 versus 4.6 percent). Acute kidney injury (AKI) and chronic kidney disease occurred more frequently among patients assigned to intensive therapy but the new-onset CKD was reduced in the intensive group.

The study showed that the rate of the primary outcome was less in the intensive-treatment group than in the standard-treatment group. Data showed the primary outcome was less by 1.77% per year as compared to 2.40% per year, the hazard ratio was 0.73, confidence interval [CI] was 95%, mortality rate was 1.06% per year as compared to1.41% per year; hazard ratio was 0.75; and confidence interval was 95% CI. The intensive-treatment group suffered from more frequent episodes of serious adverse events like hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope. When the trial and post trial data were combined and analyzed similar results were seen. ^3,4

Conclusions: Patients with increased cardiovascular risk were suggested to reduce the systolic blood pressure of less than 120 mm Hg and this resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality as compared to targeting a systolic blood pressure of less than 140 mm Hg. This was suggested during and after the trial. Some adverse events were higher in the intensive-treatment group.

Thus it was observed and recommended that intensive blood pressure control was important among patients at high cardiovascular risk.

References:

1. Internet resource. Hypertension. World Health Organization. 17 May, 2021. Accessed on 26th July 2021 from https://www.who.int/news-room/fact-sheets/detail/hypertension
2. Brent M Egan 1, Y. Z., R Neal Axon. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010, 303(20), 2043-2050.
3. SPRINT Research Group; Cora E Lewis , L. J. F., Srinivasan Beddhu, Alfred K Cheung , William C Cushman , Jeffrey A Cutler , Gregory W Evans , Karen C Johnson , Dalane W Kitzman , Suzanne Oparil , Mahboob Rahman , David M Reboussin , Michael V Rocco , Kaycee M Sink ,Joni K Snyder, Paul K Whelton1, Jeff D Williamson , Jackson T Wright Jr , Walter T Ambrosius Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. N  Engl J Med 2021, 384:, 1921-1930.
4. Johannes FE Mann, M. F. H., MD. (08, June, 2021) Goal blood pressure in adults with hypertension.

Accessed on 26th July 2021 from https://www.uptodate.com/contents/goal-blood-pressure-in-adults-with-hypertension?sectionName=Patients%20with%20established%20atherosclerotic%20cardiovascular%20disease&topicRef=8352&anchor=H2941330581&source=see_link#H2941330581