New SPRINT Analysis Predicts Extended Survival with Intensive BP Control

From Poster Presentation MDP233, AHA 2019

A new analysis of results from the SPRINT trial finds that across age groups, intensive blood pressure control may lengthen a person’s remaining lifespan by 4% to 9%.

"High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States," said lead study author Muthiah Vaduganathan, MD, MPH, instructor of medicine at Harvard Medical School and associate physician at Brigham and Women's Hospital in Boston in a press release from the American Heart Association (AHA). "These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong life span."

The findings will be presented during an oral poster session at the AHA's Scientific Sessions 2019, November 16-18, in Philadelphia.

The Systolic Blood Pressure Intervention Trial (SPRINT), published in 2015, showed that intensive BP control (systolic BP target <120 mm Hg) was superior to standard BP control (SBP <140 mmHg), reducing participants’ risk of cardiovascular (CV) events (ie, heart attack, stroke, heart failure) by 25% and mortality by 27%.

SRPINT enrolled middle-aged and older adults at high CV risk* but without diabetes and with baseline SBP readings of 130 to 180 mm Hg. The study was stopped early for benefit after median follow-up of 3 years (up to 6 years) limiting the ability to assess more long-term effects of the intensive vs standard BP control strategies on life expectancy.
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*High risk of heart disease defined by at least one of the following:

• Evidence of cardiovascular disease other than stroke,

• High 10-year cardiovascular risk score

• Chronic kidney disease

• Age ≥ 75 years 

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For the current analysis, study authors calculated the actuarial estimates of residual survival (at a given age) by using baseline age rather than time from randomization as the time axis. Residual life span at all ages (up to 95 years) was estimated using area under the survival curve. Differences in areas under the survival curves reflect estimated treatment effects on residual survival.

Mean survival benefits with intensive vs standard BP ranged from 0.5 years to 3 years (see Figure [click to enlarge]). Absolute survival gains decreased with age, but the relative benefits were relatively consistent (4% to 9%).

Results of the analysis demonstrate clear clinical benefits of more aggressive BP control. The findings also create a patient counseling opportunity as well, as summed up by Mitchell SV Elkind, MD, AHA  president-elect, chair of the advisory committee of the American Stroke Association, and professor of neurology and epidemiology at Columbia University in New York, in the AHA press release: 

"When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%...what does that number mean, in real terms? This analysis suggests that for a man who is 50-years-old, lowering blood pressure to [<120 mm Hg]…could extend your lifespan by 3 years, on average."

The study will be presented at 11:00 a.m., Sunday, November 17, 2019, during the poster session Recent Advances in Clinical Hypertension.

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