Berlowitz DR, Foy CG, Kazis LE, et al. Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes. N Engl J Med. 2017 Aug 24;377(8):733-744. doi: 10.1056/NEJMoa1611179.
Area Score
Internal Medicine
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Cardiology
Abstract

BACKGROUND: The previously published results of the Systolic Blood Pressure Intervention Trial showed that among participants with hypertension and an increased cardiovascular risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic blood pressure of less than 120 mm Hg (intensive treatment) than among those who were assigned to a target of less than 140 mm Hg (standard treatment). Whether such intensive treatment affected patient-reported outcomes was uncertain; those results from the trial are reported here.

METHODS: We randomly assigned 9361 participants with hypertension to a systolic blood-pressure target of less than 120 mm Hg or a target of less than 140 mm Hg. Patient-reported outcome measures included the scores on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Veterans RAND 12-Item Health Survey, the Patient Health Questionnaire 9-item depression scale (PHQ-9), patient-reported satisfaction with their blood-pressure care and blood-pressure medications, and adherence to blood-pressure medications. We compared the scores in the intensive-treatment group with those in the standard-treatment group among all participants and among participants stratified according to physical and cognitive function.

RESULTS: Participants who received intensive treatment received an average of one additional antihypertensive medication, and the systolic blood pressure was 14.8 mm Hg (95% confidence interval, 14.3 to 15.4) lower in the group that received intensive treatment than in the group that received standard treatment. Mean PCS, MCS, and PHQ-9 scores were relatively stable over a median of 3 years of follow-up, with no significant differences between the two treatment groups. No significant differences between the treatment groups were noted when participants were stratified according to baseline measures of physical or cognitive function. Satisfaction with blood-pressure care was high in both treatment groups, and we found no significant difference in adherence to blood-pressure medications.

CONCLUSIONS: Patient-reported outcomes among participants who received intensive treatment, which targeted a systolic blood pressure of less than 120 mm Hg, were similar to those among participants who received standard treatment, including among participants with decreased physical or cognitive function. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062 .).

Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

This paper should be read in conjunction with the earlier SPRINT trial that showed a small decrease in CVD events and an achieved BP that was higher than the target. These supplementary data show there were AEs with the more intensive treatment (one more drug on average), but was not associated with less satisfaction or subjective feelings of being unwell.

Family Medicine (FM)/General Practice (GP) rater

This follow-up on the SPRINT study of intensive blood pressure control reassures us that patients generally do not feel worse on a variety of outcome measures with more intensive control. I wish my perceived experience matched the study.

General Internal Medicine-Primary Care(US) rater

Intensively treated patients had around 15 points lower systolic BP, but no adverse effects on the many quality-of-life summaries.

Internal Medicine rater

Important to realize that lower target BP did not affect quality-of-life.

Internal Medicine rater

An important study for a geriatrician, but others have noted that the degree of frailty and cognitive impairment might not reflect what is seen in geriatric practice.