Comparison of Frequency of Atherosclerotic Cardiovascular and Safety Events With Systolic Blood Pressure <120 mm Hg Versus 135-139 mm Hg in a Systolic Blood Pressure Intervention Trial Primary Prevention Subgroup

Whether the benefit of intensive blood pressure (BP) control reduces atherosclerotic cardiovascular disease (ASCVD) risk without increasing risks of serious adverse events (SAEs) is unknown. We sought to assess differences in incident ASCVD and SAE with intensive BP control across the spectrum of 10-year ASCVD risk in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT randomized 9,361 participants who were ≥50 years old and ≥1 CVD risk factor to standard or intensive BP control (<120 or 130 to 139 mm Hg). We excluded adults with clinical ASCVD or age ≥80. We included 6,875 participants. We compared hazard ratios (HR) and risk differences (RD) of incident ASCVD events or SAEs in all and across quartiles of baseline risk. Median predicted ASCVD risk was 15.9%. Intensive BP control significantly reduced ASCVD events (HR 0.75, 95% confidence interval 0.58, 0.97, p = 0.03; RD ˗0.94; ˗1.8, ˗0.1; p = 0.03). There was no difference in effect across quartiles of ASCVD risk. There was a non-significant increase in SAE with intensive BP control (HR 1.08, 1.00, 1.17 p = 0.06; RD 2.1, ˗0.1, 4.4, p = 0.03), and no difference in this effect across quartiles of risk. In SPRINT participants without baseline clinical ASCVD, the benefit of intensive BP control for primary prevention of ASCVD may extend to lower risk participants without an increase in SAE. In conclusion, lower risk adults with stage 1 hypertension meeting SPRINT eligibility may benefit from initiation of antihypertensives.