LBOS 03-04 STRICT BLOOD PRESSURE CONTROL AS SHOWN IN THE SPRINT TRIAL: CAN IT BE GENERALIZED TO ALL ASIAN POPULATIONS?

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Abstract

Objective:

The SPRINT (Systolic Blood Pressure Intervention Trial) recently demonstrated that strict blood pressure (BP) control resulted in a lower cardiovascular disease (CVD) risk compared to standard BP control, however, this association was not observed regarding the incidence of stroke. Previous studies revealed that the contribution of BP as a risk factor was higher for stroke incidence than for any other CVD, especially in Asian populations. It is thus not clear whether the results of the SPRINT can be generalized to all Asian populations.

Design and Method:

The Japan Morning Surge Home Blood Pressure (J-HOP) Study recruited 4,310 Japanese patients with at least one CVD risk between 2005 and 2012. The home BP values of the patients were measured during a 2-week baseline period and followed for an average of 4 years. Here we compared the patients’ background and CVD event rate between the J-HOP study and the SPRINT, and we examined the association between home BP levels and stroke incidence in the J-HOP population.

Results:

The Framingham 10-year CVD risk score was 20.1% and 19.6% in the SPRINT and the J-HOP study, respectively. The stroke event rate was 0.41%/year and 0.38%/year in the SPRINT and the J-HOP study, respectively. When defining morning systolic BP <135 mmHg as the reference stratum, the J-HOP study revealed that the hazard ratios and 95% confidence intervals of stroke risk for the patients with morning home systolic BP values of 135–144 mmHg, 145–155 mmHg, and 3155 mmHg were 2.91 (1.42–5.95), 4.02 (1.92–8.43), and 7.32 (3.69–14.51), respectively. This association was not found in evening home SBP.

Conclusions:

Although there was no significant difference in stroke incidence between strict and standard BP control groups in the SPRINT, the J-HOP study demonstrated that strict BP control using home BP measurement would be important for stroke prevention in Asian populations.

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