title: Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey).
abstract: BACKGROUND
  SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated a 27% reduction in all-cause mortality with a systolic blood pressure (SBP) goal of <120 versus <140 mm Hg among US adults at high cardiovascular disease risk but without diabetes mellitus, stroke, or heart failure. To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess serious adverse events incurred if the SPRINT intensive SBP treatment goal were implemented in all eligible US adults.
  
  
  METHODS
  SPRINT eligibility criteria were applied to the 1999 to 2006 National Health and Nutrition Examination Survey and linked with the National Death Index through December 2011. SPRINT eligibility included age ≥50 years, SBP of 130 to 180 mm Hg (depending on the number of antihypertensive medications being taken), and high cardiovascular disease risk. Exclusion criteria were diabetes mellitus, history of stroke, >1 g proteinuria, heart failure, estimated glomerular filtration rate <20 mL·min-1·1.73 m-2, or dialysis. Annual mortality rates were calculated by dividing the Kaplan-Meier 5-year mortality by 5. Hazard ratios for all-cause mortality and heart failure and absolute risks for serious adverse events in SPRINT were used to estimate the number of potential deaths and heart failure cases prevented and serious adverse events incurred with intensive SBP treatment.
  
  
  RESULTS
  The mean age was 68.6 years, and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.20% (95% confidence interval [CI], 1.91-2.48), and intensive SBP treatment was projected to prevent ≈107 500 deaths per year (95% CI, 93 300-121 200) and give rise to 56 100 (95% CI, 50 800-61 400) episodes of hypotension, 34 400 (95% CI, 31 200-37 600) episodes of syncope, 43 400 (95% CI, 39 400-47 500) serious electrolyte disorders, and 88 700 (95% CI, 80 400-97 000) cases of acute kidney injury per year. The analysis-of-extremes approach indicated that the range of estimated lower- and upper-bound number of deaths prevented per year with intensive SBP control was 34 600 to 179 600. Intensive SBP control was projected to prevent 46 100 (95% CI, 41 800-50 400) cases of heart failure annually.
  
  
  CONCLUSIONS
  If fully implemented in eligible US adults, intensive SBP treatment could prevent ≈107 500 deaths per year. A consequence of this treatment strategy, however, could be an increase in serious adverse events.
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.). adam.bress@hsc.utah.edu.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Bress
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Rasha
authors.initials: R
authors.lastname: Khatib
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bansal
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Guichan
authors.initials: G
authors.lastname: Cao
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: From Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City (A.P.B., R.H.); Department of Public Health Sciences (H.K., R.K., G.C., R.D.-A., R.S.C.) and Division of Nephrology and Hypertension (H.K., V.K.B.), Loyola Medical Center, Maywood, IL; Division of Nephrology and Hypertension, University of Utah, Salt Lake City (S.B., A.K.C.); Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (R.H.); Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI (J.Y.); Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (A.E.M.); and School of Public Health, Department of Epidemiology, University of Alabama at Birmingham (P.M.).
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002986:Clinical Trials as Topic / Q000379:methods*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D065840:Protective Factors; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; hypertension; treatment outcome