Introduction: Appropriate hypertension management requires further understanding of the relationship between pulse pressure (PP, mmHg), chronological age (years) and intensity of blood pressure treatment to prevent serious adverse events (SAE).
Hypothesis: Increasing PP and advancing age are significantly associated with SAE.
Methods: A post hoc analysis of 9,361 SPRINT trial participants using the publicly available dataset (SPRINT_POP, NHLBI Biologic Specimen and Data Repository Information Coordinating Center). The primary composite outcome was any of 4 individual SAE [hypotension, syncope, electrolyte abnormalities, acute kidney injury (AKI)] chosen based on their clinical importance. Standard multivariable regression modeling techniques were utilized. Exploratory analyses for interactions were undertaken between age and PP, and between treatment assignment and age/PP.
Results: Average age was 67.9 ± 9.4 years. Individual SAE increased with PP (≤ 49: 5.6%, 50-59: 5.9%, 60-69: 7.8%, ≥ 70 10.5%, p=0.0001). In a model adjusted for baseline number of hypertension medications, sex, creatinine, body mass index and treatment assignment. A. increasing pulse pressure was significantly associated with electrolyte abnormality and AKI. B. Advancing age was significantly associated with hypotension, syncope and AKI. C. Intensive treatment assignment was significantly associated with hypotension, electrolyte abnormalities and AKI. Although age and PP were correlated (Spearman’s rho=0.47, p≤0.0001), age did not have an effect modification on PP for any SAE. No other significant interactions were noted. The relationship between age, pulse pressure stratified by treatment assignment on the composite primary outcome is shown in the figure below.
Conclusions: Although increasing age, PP and intensive treatment were each associated with SAE, there was no interaction between treatment arm and either age or PP.