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Zheutlin AR, Sharareh N, Guadamuz JS, Berchie RO, Derington CG, Jacobs JA, Mondesir FL, Alexander GC, Levitan EB, Safford M, Vos RO, Qato DM, Bress AP. Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States. J Am Heart Assoc 2024; 13:e031717. [PMID: 38390820 PMCID: PMC10944071 DOI: 10.1161/jaha.123.031717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort. METHODS AND RESULTS A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted. The authors designated pharmacy proximity by census tract using road network analysis with population-weighted centroids within a 10-minute drive time, with 5- and 20-minute sensitivity analyses. Pill bottle review measured medication use, and BP and LDL-C were assessed using standard methods. Poisson regression was used to quantify the association between pharmacy proximity with medication use and BP control, and linear regression for LDL-C. Among 16 150 REGARDS participants between 2013 and 2016, 8319 (51.5%) and 8569 (53.1%) had an indication for antihypertensive and statin medication, respectively, and pharmacy proximity data. The authors did not find a consistent association between living in a census tract with higher pharmacy proximity and antihypertensive medication use, BP control, or statin medication use and LDL-C levels, regardless of whether the area was rural, suburban, or urban. Results were similar among the 5- and 20-minute drive-time analyses. CONCLUSIONS Living in a low pharmacy proximity census tract may be associated with antihypertensive and statin medication use, or with BP control and LDL-C levels. Although, in this US cohort, outcomes were similar for adults living in high or low pharmacy proximity census tracts.
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Affiliation(s)
- Alexander R. Zheutlin
- Division of Cardiology, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Jenny S. Guadamuz
- Division of Health Policy and ManagementUniversity of California, Berkeley, School of Public HealthBerkeleyCAUSA
| | - Ransmond O. Berchie
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Catherine G. Derington
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua A. Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Favel L. Mondesir
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - G. Caleb Alexander
- Department of EpidemiologyCenter for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of MedicineJohns Hopkins MedicineBaltimoreMDUSA
| | - Emily B. Levitan
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamALUSA
| | - Monika Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Robert O. Vos
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Dima M. Qato
- Spatial Sciences Institute, Dornsife College of Letters, Arts, and SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern CaliforniaLos AngelesCAUSA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern CaliforniaLos AngelesCAUSA
- Program on Medicines and Public Health, Alfred Mann School of Pharmacy and Pharmaceutical SciencesUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Adam P. Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
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King JB, Berchie RO, Derington CG, Marcum ZA, Scharfstein DO, Greene TH, Herrick JS, Jacobs JA, Zheutlin AR, Bress AP, Cohen JB. New Users of Angiotensin II Receptor Blocker-Versus Angiotensin-Converting Enzyme Inhibitor-Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD-BP and SPRINT. J Am Heart Assoc 2023; 12:e030311. [PMID: 37646208 PMCID: PMC10547357 DOI: 10.1161/jaha.123.030311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) block distinct components of the renin-angiotensin system. Whether this translates into differential effects on cardiovascular disease events remains unclear. METHODS AND RESULTS We used the ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial and the SPRINT (Systolic Blood Pressure Intervention Trial) to emulate target trials of new users of ARBs versus ACEIs on cardiovascular disease events (primary outcome) and death (secondary outcome). We estimated marginal cause-specific hazard ratios (HRs) and treatment-specific cumulative incidence functions with inverse probability of treatment weights. We identified 3298 new users of ARBs or ACEIs (ACCORD-BP: 374 ARB versus 884 ACEI; SPRINT: 727 ARB versus 1313 ACEI). For participants initiating ARBs versus ACEIs, the inverse probability of treatment weight rate of the primary outcome was 3.2 versus 3.5 per 100 person-years in ACCORD-BP (HR, 0.91 [95% CI, 0.63-1.31]) and 1.8 versus 2.2 per 100 person-years in SPRINT (HR, 0.81 [95% CI, 0.56-1.18]). There were no appreciable differences in pooled analyses, except that ARBs versus ACEIs were associated with a lower death rate (HR, 0.56 [95% CI, 0.37-0.85]). ARBs were associated with a lower rate of the primary outcome among subgroups of male versus female participants, non-Hispanic Black versus non-Hispanic White participants, and those randomly assigned to standard versus intensive blood pressure (Pinteraction: <0.01, 0.05, and <0.01, respectively). CONCLUSIONS In this secondary analysis of ACCORD-BP and SPRINT, new users of ARB- versus ACEI-based antihypertensive medication regimens experienced similar cardiovascular disease events rates, with important subgroup differences and lower rates of death overall. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01206062, NCT00000620.
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Affiliation(s)
- Jordan B. King
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
- Institute for Health ResearchKaiser Permanente ColoradoCOAuroraUSA
| | - Ransmond O. Berchie
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Catherine G. Derington
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Zachary A. Marcum
- Department of Pharmacy, School of PharmacyUniversity of WashingtonWASeattleUSA
| | - Daniel O. Scharfstein
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Tom H. Greene
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
- Department of Internal MedicineUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Jennifer S. Herrick
- Department of Internal MedicineUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Joshua A. Jacobs
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Alexander R. Zheutlin
- Division of CardiologyFeinberg School of Medicine, Northwestern UniversityChicagoILUSA
| | - Adam P. Bress
- Intermountain Healthcare Department of Population Health SciencesUniversity of Utah Spencer Fox Eccles School of MedicineUTSalt Lake CityUSA
| | - Jordana B. Cohen
- Department of Medicine, Renal‐Electrolyte and Hypertension DivisionPerelman School of Medicine at the University of PennsylvaniaPAPhiladelphiaUSA
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine, University of PennsylvaniaPAPhiladelphiaUSA
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Derington CG, Bress AP, Berchie RO, Herrick JS, Shen J, Ying J, Greene T, Tajeu GS, Sakhuja S, Ruiz-Negrón N, Zhang Y, Howard G, Levitan EB, Muntner P, Safford MM, Whelton PK, Weintraub WS, Moran AE, Bellows BK. Estimated Population Health Benefits of Intensive Systolic Blood Pressure Treatment Among SPRINT-Eligible US Adults. Am J Hypertens 2023; 36:498-508. [PMID: 37378472 PMCID: PMC10403972 DOI: 10.1093/ajh/hpad047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated an intensive (<120 mm Hg) vs. standard (<140 mm Hg) systolic blood pressure (SBP) goal lowered cardiovascular disease (CVD) risk. Estimating the effect of intensive SBP lowering among SPRINT-eligible adults most likely to benefit can guide implementation efforts. METHODS We studied SPRINT participants and SPRINT-eligible participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study and National Health and Nutrition Examination Surveys (NHANES). A published algorithm of predicted CVD benefit with intensive SBP treatment was used to categorize participants into low, medium, or high predicted benefit. CVD event rates were estimated with intensive and standard treatment. RESULTS Median age was 67.0, 72.0, and 64.0 years in SPRINT, SPRINT-eligible REGARDS, and SPRINT-eligible NHANES participants, respectively. The proportion with high predicted benefit was 33.0% in SPRINT, 39.0% in SPRINT-eligible REGARDS, and 23.5% in SPRINT-eligible NHANES. The estimated difference in CVD event rate (standard minus intensive) was 7.0 (95% confidence interval [CI] 3.4-10.7), 8.4 (95% CI 8.2-8.5), and 6.1 (95% CI 5.9-6.3) per 1,000 person-years in SPRINT, SPRINT-eligible REGARDS participants, and SPRINT-eligible NHANES participants, respectively (median 3.2-year follow-up). Intensive SBP treatment could prevent 84,300 (95% CI 80,800-87,920) CVD events per year in 14.1 million SPRINT-eligible US adults; 29,400 and 28,600 would be in 7.0 million individuals with medium or high predicted benefit, respectively. CONCLUSIONS Most of the population health benefit from intensive SBP goals could be achieved by treating those characterized by a previously published algorithm as having medium or high predicted benefit.
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Affiliation(s)
- Catherine G Derington
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Adam P Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ransmond O Berchie
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer S Herrick
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jincheng Shen
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jian Ying
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Natalia Ruiz-Negrón
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Yiyi Zhang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - George Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - William S Weintraub
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
- MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Brandon K Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Derington CG, Bress AP, Herrick JS, Jacobs JA, Zheutlin AR, Berchie RO, Conroy MB, Cushman WC, King JB. Antihypertensive Medication Regimens Used by US Adults With Hypertension and the Potential for Fixed-Dose Combination Products: The National Health and Nutrition Examination Surveys 2015 to 2020. J Am Heart Assoc 2023; 12:e028573. [PMID: 37158068 PMCID: PMC10381985 DOI: 10.1161/jaha.122.028573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/20/2023] [Indexed: 05/10/2023]
Abstract
Background Fixed-dose combination (FDC) antihypertensive products improve blood pressure control and adherence among patients with hypertension. It is unknown to what degree commercially available FDC products meet the current hypertension management prescription patterns in the United States. Methods and Results This cross-sectional analysis of the National Health and Nutrition Examination Surveys 2015 to March 2020 included participants with hypertension taking ≥2 antihypertensive medications (N=2451). After constructing each participant's regimen according to antihypertensive classes used, we estimated the extent to which the 7 class-level FDC regimens available in the United States as of January 2023 would match the regimens used. Among a weighted population of 34.1 million US adults (mean age, 66.0 years; 52.8% women; 69.1% non-Hispanic White race and ethnicity), the proportions using 2, 3, 4, and ≥5 antihypertensive classes were 60.6%, 28.2%, 9.1%, and 1.6%, respectively. The 7 FDC regimens were among 189 total regimens used (3.7%), and 39.2% of the population used one of the FDC regimens (95% CI, 35.5%-43.0%; 13.4 million US adults); 60.8% of the population (95% CI, 57.0%-64.5%; 20.7 million US adults) were using a regimen not available as a class-equivalent FDC product. Conclusions Three in 5 US adults with hypertension taking ≥2 antihypertensive classes are using a regimen that is not commercially available as a class-equivalent FDC product as of January 2023. To maximize the potential benefit of FDCs to improve medication adherence (and thus blood pressure control) among patients taking multiple antihypertensive medications, use of FDC-compatible regimens and improvements in the product landscape are needed.
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Affiliation(s)
- Catherine G. Derington
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Adam P. Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Jennifer S. Herrick
- Department of Internal Medicine, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua A. Jacobs
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Alexander R. Zheutlin
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
- Department of Internal Medicine, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Ransmond O. Berchie
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
- Department of Internal Medicine, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Molly B. Conroy
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
- Department of Internal Medicine, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
| | - William C. Cushman
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterTNMemphisUSA
| | - Jordan B. King
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUTUSA
- Institute for Health Research, Kaiser Permanente ColoradoAuroraCOUSA
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Zheutlin AR, Derington CG, King JB, Berchie RO, Herrick JS, Dixon DL, Cohen JB, Shimbo D, Kronish IM, Saseen JJ, Muntner P, Moran AE, Bress AP. Factors associated with antihypertensive monotherapy among US adults with treated hypertension and uncontrolled blood pressure overall and by race/ethnicity, National Health and Nutrition Examination Survey 2013-2018. Am Heart J 2022; 248:150-159. [PMID: 34662571 PMCID: PMC9012814 DOI: 10.1016/j.ahj.2021.10.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treating hypertension with antihypertensive medications combinations, rather than one medication (ie, monotherapy), is underused in the United States, particularly in certain race/ethnic groups. Identifying factors associated with monotherapy use despite uncontrolled blood pressure (BP) overall and within race/ethnic groups may elucidate intervention targets in under-treated populations. METHODS Cross-sectional analysis of National Health and Nutrition Examination Surveys (NHANES; 2013-2014 through 2017-2018). We included participants age ≥20 years with hypertension, taking at least one antihypertensive medication, and uncontrolled BP (systolic BP [SBP] ≥ 140 mmHg or diastolic BP [DBP] ≥ 90 mmHg). Demographic, clinical, and healthcare-access factors associated with antihypertensive monotherapy were determined using multivariable-adjusted Poisson regression. RESULTS Among 1,597 participants with hypertension and uncontrolled BP, age- and sex- adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults. Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use. CONCLUSION Clinical and healthcare-access factors, including a healthcare visit within the previous year and co-morbid conditions were associated with a higher likelihood of combination antihypertensive therapy.
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Affiliation(s)
- Alexander R Zheutlin
- Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT.
| | - Catherine G Derington
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT
| | - Jordan B King
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Ransmond O Berchie
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT
| | - Jennifer S Herrick
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Daichi Shimbo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ian M Kronish
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO; Department of Family Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT
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Derington CG, Bellows B, Tajeu GS, Herrick JS, Berchie RO, Ying J, Sakhuja S, Greene T, Ruiz-negron N, Howard G, Levitan EB, Muntner P, Safford MM, Weintraub WS, Moran AE, Bress AP. Abstract 02: Distribution Of Predicted Cardiovascular And All-cause Mortality Benefit Of Intensive Vs Standard Blood Pressure Control Among Us Adults Eligible For The Systolic Blood Pressure Intervention Trial. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
If resources are scarce, achieving national SBP control goals will require prioritizing treatment among those likely to benefit. To identify patients with greatest predicted benefit with intensive SBP treatment and estimate population sizes, we applied algorithms to community samples who met the SPRINT enrollment criteria.
Methods:
The published algorithms separately predict the absolute risk reduction in CVD events and mortality at 3.26 years with intensive (<120 mm Hg) vs standard (<140 mm Hg) SBP lowering. We applied and calibrated the algorithms to SPRINT standard arm participants (n=4 399) and samples meeting SPRINT enrollment criteria from the National Health and Nutrition Examination Survey (NHANES, n=1 297) and the Reasons for Geographic And Racial Differences in Stroke (REGARDS, n=2 785). Predicted absolute risk reduction estimated number needed to treat (NNT), categorized as <50, 50-100, and ≥100. Observed 3.26 year CVD event (SPRINT, REGARDS) and mortality rates (all cohorts) were calculated.
Results:
The median ages were 67 (SPRINT), 69 (NHANES), and 72 (REGARDS). Greater proportions of NHANES and REGARDS vs SPRINT had predicted NNT <100 for CVD events (NHANES 94.8%, REGARDS 99.2%, SPRINT 87.8%) and mortality (NHANES 64.3%, REGARDS 63.7%, SPRINT 38.8%) (
Table
). Event rates were comparable within NNT groups.
Conclusions:
Predicted NNT distributions differ between cohorts but event rates are similar. Most adults who meet SPRINT enrollment criteria have predicted NNT <100 for CVD and mortality with intensive SBP treatment. These results suggest that published algorithms can identify those most likely to benefit and can guide implementation.
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Affiliation(s)
| | | | | | | | | | | | | | - Tom Greene
- Univ of Utah, Salt Lake City, United States Minor Outlying Islands
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