Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort

Kathleen Dungan, Timothy E. Craven, Kyaw Soe, Jackson T. Wright, Jan Basile, William E Haley, Nancy R. Kressin, Uzma Rani, Leonardo Tamariz, Jeff Whittle, Alan Wiggers, Kwame Osei

Research output: Contribution to journalArticle

Abstract

Aims: To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. Methods: We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120mm Hg (intensive group, N=4544) or an SBP target of <140mm Hg (standard group, N=4553). The median follow-up was 3.26years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. Results: Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3±5.6 vs 33.0±5.3kg/m2; P<.01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction=.98). Similarly, there was no evidence of treatment×MetS subgroup interaction for all-cause mortality (adjusted interaction P value=.98). The findings were also similar across race/ethnic subgroups. Conclusions: In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

Original languageEnglish (US)
JournalDiabetes, Obesity and Metabolism
DOIs
StateAccepted/In press - 2017

Fingerprint

Blood Pressure
Confidence Intervals
Acute Coronary Syndrome
Hispanic Americans
Infarction
Body Mass Index
Heart Failure
Stroke
Myocardial Infarction
Mortality
Therapeutics

Keywords

  • Cardiovascular disease
  • Clinical trial
  • Glucose metabolism
  • Insulin resistance
  • Macrovascular disease
  • Randomized trial

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort. / Dungan, Kathleen; Craven, Timothy E.; Soe, Kyaw; Wright, Jackson T.; Basile, Jan; Haley, William E; Kressin, Nancy R.; Rani, Uzma; Tamariz, Leonardo; Whittle, Jeff; Wiggers, Alan; Osei, Kwame.

In: Diabetes, Obesity and Metabolism, 2017.

Research output: Contribution to journalArticle

Dungan, Kathleen ; Craven, Timothy E. ; Soe, Kyaw ; Wright, Jackson T. ; Basile, Jan ; Haley, William E ; Kressin, Nancy R. ; Rani, Uzma ; Tamariz, Leonardo ; Whittle, Jeff ; Wiggers, Alan ; Osei, Kwame. / Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort. In: Diabetes, Obesity and Metabolism. 2017.
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abstract = "Aims: To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. Methods: We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120mm Hg (intensive group, N=4544) or an SBP target of <140mm Hg (standard group, N=4553). The median follow-up was 3.26years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. Results: Overall, 3521/9097 participants (38.7{\%}) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3±5.6 vs 33.0±5.3kg/m2; P<.01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95{\%} confidence interval [CI] 0.57, 0.96) and 0.71 (95{\%} CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction=.98). Similarly, there was no evidence of treatment×MetS subgroup interaction for all-cause mortality (adjusted interaction P value=.98). The findings were also similar across race/ethnic subgroups. Conclusions: In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.",
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T1 - Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort

AU - Dungan, Kathleen

AU - Craven, Timothy E.

AU - Soe, Kyaw

AU - Wright, Jackson T.

AU - Basile, Jan

AU - Haley, William E

AU - Kressin, Nancy R.

AU - Rani, Uzma

AU - Tamariz, Leonardo

AU - Whittle, Jeff

AU - Wiggers, Alan

AU - Osei, Kwame

PY - 2017

Y1 - 2017

N2 - Aims: To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. Methods: We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120mm Hg (intensive group, N=4544) or an SBP target of <140mm Hg (standard group, N=4553). The median follow-up was 3.26years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. Results: Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3±5.6 vs 33.0±5.3kg/m2; P<.01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction=.98). Similarly, there was no evidence of treatment×MetS subgroup interaction for all-cause mortality (adjusted interaction P value=.98). The findings were also similar across race/ethnic subgroups. Conclusions: In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

AB - Aims: To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. Methods: We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120mm Hg (intensive group, N=4544) or an SBP target of <140mm Hg (standard group, N=4553). The median follow-up was 3.26years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. Results: Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3±5.6 vs 33.0±5.3kg/m2; P<.01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction=.98). Similarly, there was no evidence of treatment×MetS subgroup interaction for all-cause mortality (adjusted interaction P value=.98). The findings were also similar across race/ethnic subgroups. Conclusions: In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

KW - Cardiovascular disease

KW - Clinical trial

KW - Glucose metabolism

KW - Insulin resistance

KW - Macrovascular disease

KW - Randomized trial

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