PREVENT equations identify individuals who will benefit from intensive SBP control

The reduction in relative risk with intensive vs standard systolic blood pressure (SBP) treatment among individuals without baseline cardiovascular disease (CVD) is consistent across the risk strata using the PREVENT* equations, as shown in the SPRINT study.

On the other hand, variations in the absolute risks are observed from the low- or borderline-risk group to the high-risk group.

A team of investigators performed a secondary analysis of SPRINT in 6,554 participants (meana ge 65 years, 37 percent women, 53 percent non-Hispanic White) without prevalent CVD and with complete data. They calculated the baseline PREVENT 10-year risk for total CVD, which was categorized as low or borderline (<7.5 percent), intermediate (7.5 percent to <20 percent), and high (≥20 percent).

The hazard ratios (HRs) and 4-year absolute risk differences across these groups were estimated for the effect of intensive (<120 mm Hg) vs standard (<140 mm Hg) SBP treatment on the primary composite outcome (ie, myocardial infarction, acute coronary syndrome, heart failure, CVD death, or stroke) and treatment-related serious adverse events.

The median PREVENT_base 10-year risk was 13 percent for total CVD. Of the participants, 16 percent were categorized as low or borderline risk, 62 percent as intermediate risk, and 22 percent as high risk.

Over a median follow-up of 3.86 years, the HRs for CVD events comparing intensive with standard treatment were 0.74 (95 percent confidence interval [CI], 0.33–1.66) for low or borderline risk, 0.70 (95 percent CI, 0.52–0.93) for intermediate risk, and 0.85 (95 percent CI, 0.60–1.20) for high risk (p_interaction=0.68), with 4-year absolute risk differences of 0.002, 0.015, and 0.024, respectively.

Likewise, no evidence of interaction was seen on the relative risk scale across PREVENT strata for serious adverse events with intensive vs standard treatment (low or borderline: HR, 1.12, 95 percent CI, 0.53–2.38; intermediate: HR, 1.66, 95 percent CI, 1.24–2.24; high: HR, 1.28, 95 percent CI, 0.87–1.87; p_interaction=0.44).

“These findings underscore the utility of PREVENT to identify those most likely to derive substantial absolute benefit from intensive SBP control for primary prevention,” the investigators said.

*Predicting Risk of Cardiovascular Disease Events