Gitsels, Lisanne A;
Kulinskaya, Elena;
Bakbergenuly, Ilyas;
Steel, Nicholas;
(2017)
Outcomes of blood pressure targets in clinical trial versus primary care setting.
Presented at: Annual Conference of the International Society for Clinical Biostatistics (ISCB 2017), Vigo, Spain.
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Abstract
Objective: The primary objective was to compare outcomes of different systolic blood pressure (SBP) targets in the US clinical setting and the UK primary care setting. / Methods: Data from the SPRINT randomised control trial and The Health Improvement Network (THIN) primary care database were used to develop survival models for longevity and adverse renal outcome (ARO, main adverse effect) at different SBP targets given treatment in people without diabetes and chronic kidney disease. The hazard of all-cause mortality or ARO associated with SBP targets was calculated by a multilevel Cox’s proportional hazards regression, adjusted for sex, age, race, smoking, BMI, SBP, cardiovascular disease, number of antihypertensive agents at baseline, additional medication after trial entry, their interaction, and clinical site. / Results: Compared to SBP target of ≤120 mmHg, SBP target of ≤140 mmHg was associated with increased hazard of mortality of 1.42 (1.06-1.90) in SPRINT, but with decreased hazard of 0.70 (0.65-0.76) in THIN. Both in SPRINT and THIN, SBP target of ≤140 mmHg was associated with decreased hazard of ARO of 0.32 (0.22-0.46) and 0.87 (0.80-0.95), respectively. Additional antihypertensive agents (3+) were associated with increased hazards of both outcomes, with HRs of 1.71-1.74 in SPRINT and 1.43-2.23 in THIN, yet being on 2 agents had survival benefits in SPRINT (HRs 0.70-0.79). / Conclusions: Lower SBP target was associated with survival benefits in the clinical setting, but with increased hazard of mortality in the primary care setting. In both settings, polypharmacy patients tended to be worse off. An intensive control of SBP may benefit a selected subgroup of patients, but it appears harmful for the broader population.
| Type: | Poster |
|---|---|
| Title: | Outcomes of blood pressure targets in clinical trial versus primary care setting |
| Event: | Annual Conference of the International Society for Clinical Biostatistics (ISCB 2017) |
| Location: | Vigo, Spain |
| Dates: | 09 - 13 July 2017 |
| Open access status: | An open access version is available from UCL Discovery |
| Publisher version: | https://www.iscb.info/iscb-annual-conference/ |
| Language: | English |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10146416 |
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