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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics
JACC: Heart Failure, Volume 7, No. 12, Year 2019
Notification
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Description
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 (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83). 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). © 2019 American College of Cardiology Foundation
Authors & Co-Authors
Upadhya, Bharathi
United States, Winston Salem
Wake Forest University School of Medicine
Lovato, Laura C.
United States, Winston Salem
Wake Forest University School of Medicine
Rocco, Michael V.
United States, Winston Salem
Wake Forest University School of Medicine
Lewis, Cora Elizabeth
United States, Birmingham
The University of Alabama at Birmingham
Oparil, Suzanne
United States, Birmingham
The University of Alabama at Birmingham
Cushman, William C.
United States, Memphis
Memphis va Medical Center
Rodriguez, Carlos Jose
United States, Winston Salem
Wake Forest University School of Medicine
Rosendorff, Clive
United States, New York
Icahn School of Medicine at Mount Sinai
Kitzman, Dalane W.
United States
Va Medical Center
Statistics
Citations: 7
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1016/j.jchf.2019.08.018
ISSN:
22131779
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Randomised Control Trial