Would Risk-Stratified Intensive Blood Pressure Lowering Prevent Heart Failure More Effectively?

Objectives Hypertension is the leading risk factor contributing to population burden of heart failure (HF). While the SPRINT trial demonstrated intensive blood pressure (BP) lowering ( Methods We conducted a post-hoc analysis using SPRINT data from the publicly available National Heart Lung and Blood Institute BioLINCC data repository. We included participants with available HF risk factor data. We excluded participants with prevalent cardiovascular disease and those older than 80 years at baseline. We applied a published 10-year incident HF risk prediction model (derived and validated in 7 population-based cohorts) and stratified trial participants into 1) low, 2) intermediate, or 3) high HF risk categories by tertiles of predicted HF risk at baseline. We performed Kaplan-Meier Survival analysis and multivariable Cox proportional hazards models to test the effect of intensive vs. standard BP lowering on incident HF in each baseline HF risk category adjusting for age, sex, and race. Results A total of 6,911 individuals were included in the analysis with a mean follow-up time of 3.3 years, during which 77 incident HF events occurred. Low 10-year predicted HF risk ranged from 0.6-5.4% (N=2303), intermediate 5.4-9.0% (N=2304), and high 9.0-50.3% (N=2304) at baseline. Individuals in the high HF risk group were older, had a higher systolic BP, and higher fasting glucose level at baseline (p Conclusion Benefits of intensive BP lowering for HF prevention may be maximized among individuals at high predicted risk of HF.