Hypertension is a known risk factor for cardiovascular disease (CVD) and reducing blood pressure (BP) using lifestyle interventions and pharmacological therapy can decrease CVD and mortality risk.

The Systolic Blood Pressure Intervention Trial (SPRINT) has shown the beneficial effect of intensive BP reduction in patients with hypertension, including the elderly. A recent study, published in the Journal of the American Heart Association, evaluated the impact of comorbidities on the outcomes of intensive BP reduction in SPRINT participants.

Using SPRINT data, the comorbidity score was calculated for every patient based on the Charlson Comorbidity Index (CCI). On the basis of CCI scores, a total of 9361 patients were divided into 3 groups (0, 1-2, 3 or more). Cardiovascular and cerebrovascular comorbidities were higher in those with higher CCI scores. Intensive BP control significantly reduced major adverse cardiovascular and cerebrovascular events (MACCEs) among patients having CCI scores 0 and 1-2 compared to standard treatment (7.1% compared to 10.9%; 12.8% compared to 17.2%); however, this was not noted in those having scores of 3 or more (23.3% compared to 23.5%). Intensive BP control was also associated with a lower risk of cardiovascular mortality across all CCI groups.

Subgroup analyses revealed that intensive BP reduction was associated with reduced risk of MACCEs in most demographic and clinical subgroups having mild or moderate comorbidities. However, in those with severe comorbidity, the benefit of intensive control was noted only in those with atrial fibrillation. Drugs like nonselective β‐blockers and diuretics were found to be linked to a greater risk of MACCEs in those with mild comorbidities.

The study concluded that intensive BP control was associated with a reduction in cardiovascular events and mortality among patients having mild or moderate comorbidities, especially in those with mild comorbidities. emedinexus

Reference:

Zheng W, Li S, Jiang C, et al. Effect of Intensive Blood Pressure Control and Comorbidity Status on the Prognosis of Patients With Hypertension: Insights From SPRINT. J Am Heart Assoc. 2025 Mar 18;14(6):e036719. doi: 10.1161/JAHA.124.036719; https://www.ahajournals.org/doi/full/10.1161/JAHA.124.036719