Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics.
Bharathi Upadhya,Laura C. Lovato,Michael V. Rocco,Cora E. Lewis,Suzanne Oparil,William C. Cushman,John B. Kostis,Carlos J. Rodriguez,Monique E. Cho,Loretta W. Cloud,Anjay Rastogi,Clive Rosendorff,Dalane W. Kitzman +12 more
TLDR
No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use.Abstract:
Objectives This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. Background SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. Methods Detailed use of medication data prospectively collected throughout the trial were examined. Results ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop ( Conclusions No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062 ).read more
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Hypertension as a Road to Treatment of Heart Failure with Preserved Ejection Fraction
TL;DR: Focusing on the tremendous overlap of hypertensive heart disease with HFpEF, it is proposed that approaches currently used to guide therapies for hypertension be applied to the treatment ofHFpEF.
Journal ArticleDOI
Incidence and Outcomes of Acute Heart Failure With Preserved Versus Reduced Ejection Fraction in SPRINT.
Bharathi Upadhya,James J Willard,Laura C. Lovato,Michael V. Rocco,Cora E. Lewis,Suzanne Oparil,William C. Cushman,Jeffrey T. Bates,Natalie A. Bello,Gerard P. Aurigemma,Karen C. Johnson,Carlos J. Rodriguez,Dominic S. Raj,Anjay Rastogi,Leonardo Tamariz,Leonardo Tamariz,Alan Wiggers,Dalane W. Kitzman +17 more
TL;DR: In this paper, the SPRINT (Systolic Blood Pressure Intervention Trial) showed that intensive BP treatment reduced acute decompensated heart failure (ADHF) events, and the effect on HF with preserv...
Journal ArticleDOI
SPRINT Revisited: Updated Results and Implications.
Jackson T. Wright,Paul K. Whelton,Karen C. Johnson,Joni K. Snyder,David M. Reboussin,William C. Cushman,Jeff D. Williamson,Nicholas M. Pajewski,Alfred K. Cheung,Cora E. Lewis,Suzanne Oparil,Michael V. Rocco,Srinivasan Beddhu,Lawrence J. Fine,Jeffrey A. Cutler,Walter T. Ambrosius,Mahboob Rahman,Carolyn H Still,Zhengyi Chen,Curtis Tatsuoka +19 more
TL;DR: The SPRINT (Systolic Blood Pressure Intervention Trial) results have influenced clinical practice but have also generated discussion regarding the validity, generalizability, and importance of the trial as mentioned in this paper.
Journal ArticleDOI
Heart Failure Events in a Clinical Trial on Arterial Hypertension: New Insights Into the SPRINT Trial
TL;DR: In this paper, the SPRINT data were analyzed with a redefined composite end point including myocardial infarction, acute coronary syndrome other than mycardial infrction, stroke, and cardiovascular death (excluding heart failure events).
Journal ArticleDOI
Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction
TL;DR: The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive for heart failure in congestive failure with reduced ejection fraction.
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TL;DR: The next generation of leaders in the field of FACC/FAHA education and training will be shaped by the experiences of the past 50 years, which will help shape the future of the profession.
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A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
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