Effect of intensive blood pressure treatment on heart failure events in the systolic blood pressure reduction intervention trial
Open accessAbstract
Background— Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg). Methods and Results— ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46–0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase ( P <0.001) in cardiovascular death. Conclusions— Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01206062
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In the SPRINT trial, intensive treatment of hypertension decreased the risk for development of incident heart failure by 36%.
“Similarly, in the SPRINT trial, intensive treatment of hypertension decreased the risk for development of incident heart failure by 36% (277).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [277]
The Conclusions report a 36% reduction in acute decompensated heart failure (ADHF) with intensive blood-pressure treatment in SPRINT. The Methods (Study Outcomes) say all ADHF events were incident heart-failure events, but define them as events requiring hospital or emergency-department treatment. The claim broadens that specific outcome to incident heart failure generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the SPRINT trial, the risk for development of incident heart failure decreased by 36%.
“Intensive treatment of hypertension in people with diabetes in the BPROAD trial led to a 34% reduction in treatment or hospitalization for heart failure (HR 0.66, 95% CI 0.41–1.04), a finding that parallels observations from the SPRINT trial where the risk for development of incident heart failure decreased by 36% (42,274).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [274]
The Conclusions report a 36% reduction in acute decompensated heart failure (ADHF) with intensive blood-pressure treatment in SPRINT. The Discussion says new outpatient heart failure was not counted, so the result does not establish a 36% reduction in incident heart failure overall. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn the BPROAD trial, intensive treatment of hypertension in people with diabetes led to a 34% reduction in treatment or hospitalization for heart failure (HR 0.66, 95% CI 0.41-1.04).
“Intensive treatment of hypertension in people with diabetes in the BPROAD trial led to a 34% reduction in treatment or hospitalization for heart failure (HR 0.66, 95% CI 0.41–1.04), a finding that parallels observations from the SPRINT trial where the risk for development of incident heart failure decreased by 36% (42,274).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [274]
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CHRONIC HEART FAILURE EPIDEMIOLOGY IN KAZAKHSTAN AND OTHER COUNTRIES
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- Authors
- Upadhya, B., Rocco, M., Lewis, C. E., Oparil, S., Lovato, L. C., Cushman, W. C., Bates, J. T., Bello, N. A., Aurigemma, G., Fine, L. J., Johnson, K. C., Rodriguez, C. J., Raj, D. S., Rastogi, A., Tamariz, L., Wiggers, A., & Kitzman, D. W.
- Affiliations
- University of Alabama (US)
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College...
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2017-04
- Volume
- 10
- Issue
- 4
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC5384646
- OpenAlex
- W2601765095
- Cited by
- 118
- References
- 46
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 8 · 2023: 8 · 2022: 16 · 2021: 15 · 2020: 20 · 2019: 19 · 2018: 9 · 2017: 3 · 2016: 1
- FWCI
- 10.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Amgen
- Gilead Sciences
- University of California
- George Washington University
- University of Michigan
- University of Florida
- University of Utah
- University of Pittsburgh
- National Institutes of Health (UL1TR000093, UL1TR000050, UL1TR000073, UL1TR001064, UL1TR000002, UL1TR000075, UL1TR000064, UL1TR000005, UL1TR000433, UL1TR000003, UL1TR000445, UL1TR000439, UL1TR000105)
- University of Illinois at Urbana-Champaign
- Relypsa
- National Institute on Aging (R01AG020583, R01AG018915, R01AG045551, P30AG021332)
- National Heart, Lung, and Blood Institute (R01HL107257, HHSN268200900040C, HHSN268200900049C, HHSN268200900048C, HHSN268200900047C, HHSN268200900046C)
- National Institute of General Medical Sciences (P30GM103337)
- National Center for Research Resources (UL1RR025755, UL1RR024134, UL1RR025752, UL1RR025771)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- acute decompensated heart failure, intensive blood pressure lowering, systolic blood pressure, SPRINT trial, cardiovascular mortality, chronic kidney disease, cardiovascular disease, older adults, race and sex differences, subgroup analysis
- MeSH terms
- Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Female, Heart Failure, Hospitalization, Humans, Hypertension, Male, Middle Aged, Risk Factors, Time Factors, Comorbidity, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Kaplan-Meier Estimate
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