Intensive Blood Pressure Lowering to 120 mm Hg Reduces Cardiovascular Events

Conceitos essenciais

Lowering blood pressure to 120 mm Hg reduces cardiovascular events significantly.

Resumo

The ESPRIT trial focused on intensive blood pressure lowering to a systolic target below 120 mm Hg compared to standard treatment targeting below 140 mm Hg. Lead investigator Jing Li reported a 12% lower incidence of major vascular events, 39% lower cardiovascular mortality, and 21% lower all-cause mortality with intensive treatment. The trial included high-risk individuals, including those with diabetes and a history of stroke, showing benefits extended to these groups. Results indicated the prevention of 14 major vascular events and eight deaths per 1000 individuals treated for 3 years. The trial highlighted the potential to save lives and reduce heart disease burden globally. The study was presented at the AHA Scientific Sessions 2023, involving 11,255 Chinese adults with baseline systolic blood pressure measurements. The primary outcome showed a 12% reduction in events with intensive treatment, with positive trends in individual endpoints. Serious adverse events included an increase in syncope in the intensive group.

Estatísticas

"Intensive blood pressure lowering treatment targeting a systolic pressure below 120 mm Hg for 3 years resulted in a 12% lower incidence of major vascular events, a 39% lower cardiovascular mortality, and 21% lower all-cause mortality than the standard treatment targeting a systolic pressure below 140 mm Hg," reported lead investigator, Jing Li, MD.
"After 3.4 years of follow-up, 624 primary outcome events had occurred in the standard arm (3.6%) vs 547 events in intensive arm (3.2%), a reduction of 12% (hazard ratio [HR], 0.88; 95% CI, 0.78-0.99)."
"Cardiovascular death occurred in 0.5% of the standard group vs 0.3% of the intensive group (HR 0.61; 95% CI, 0.44-0.84); and all-cause death occurred in 1.1% of the standard group vs 0.9% of the intensive group (HR, 0.79; 95% CI, 0.64-0.97)."

Citações

"When we look at meta-analysis of trials of different levels of blood pressure reduction, all the studies show the same thing – the lower the blood pressure, the better the outcome, with those starting at higher levels gaining the greatest benefit of blood pressure reductions," noted Paul Whelton, MD.
"ESPRIT is a nicely done trial. It is reassuring because it is consistent with the other trials, in that it seems that the benefits are much greater than the risk of adverse effects," added Whelton.

Principais Insights Extraídos De

More Evidence of Better Outcomes With 120 mm Hg BP Target

by Sue Hughes às www.medscape.com 11-16-2023

https://www.medscape.com/viewarticle/998564

Perguntas Mais Profundas

What are the implications of implementing a lower systolic blood pressure target of 120 mm Hg in clinical practice

Implementing a lower systolic blood pressure target of 120 mm Hg in clinical practice has significant implications for improving cardiovascular outcomes in high-risk individuals. The findings from the ESPRIT trial suggest that intensive blood pressure lowering to this target resulted in a 12% lower incidence of major vascular events, a 39% lower cardiovascular mortality, and a 21% lower all-cause mortality compared to the standard treatment targeting < 140 mm Hg. This indicates that striving for a lower target can potentially save more lives and reduce the burden of heart disease globally. However, the implementation of this lower target would require healthcare providers to adjust their treatment protocols, closely monitor patients for adverse effects like syncope, and ensure adherence to the new guidelines. Additionally, patient education on the benefits of intensive blood pressure control and regular follow-ups would be crucial in achieving optimal outcomes.

How can the findings of the ESPRIT trial be applied to different ethnic populations

The findings of the ESPRIT trial can be applied to different ethnic populations by recognizing the consistency of benefits across diverse groups. While the trial focused on a Chinese population, the results align with previous studies in other ethnicities, indicating that the benefits of intensive blood pressure lowering extend beyond specific demographics. Healthcare systems can use these findings to inform treatment strategies for high-risk individuals from various ethnic backgrounds, emphasizing the importance of individualized care based on the patient's risk factors and medical history. By acknowledging the universal benefits of lower blood pressure targets demonstrated in the trial, healthcare providers can tailor interventions to suit the specific needs of different ethnic populations, ultimately improving cardiovascular outcomes on a global scale.

How can healthcare systems bridge the gap between scientific evidence and real-world implementation of lower blood pressure targets

To bridge the gap between scientific evidence and real-world implementation of lower blood pressure targets, healthcare systems need to focus on improving adherence to treatment guidelines and enhancing patient education and engagement. One approach is to adopt a team-based care model where nonphysician healthcare professionals play a significant role in patient follow-up and monitoring. This collaborative approach can help ensure that patients receive consistent care, adhere to treatment plans, and achieve their blood pressure targets effectively. Additionally, healthcare systems should invest in resources for continuous medical education to update providers on the latest evidence-based practices and guidelines. By integrating these strategies into clinical practice, healthcare systems can work towards closing the gap between scientific evidence and the implementation of lower blood pressure targets, ultimately improving patient outcomes and reducing the global burden of cardiovascular disease.