Intensive Blood Pressure Treatment for Resistant Hypertension: Secondary Analysis of a Randomized Controlled Trial

Evidence about the target blood pressure (BP) in patients with resistant hypertension is limited. The present study aimed to assess the efficacy of intensive BP treatment (systolic BP target, <120 mmHg) versus standard BP treatment (systolic BP target, <140 mmHg) in patients with resistant hypertension. This is a secondary analysis using data from SPRINT (Systolic Blood Pressure Intervention Trial). This study included 1397 patients with resistant hypertension and 7698 without resistant hypertension. Using the Cox proportional hazards model, we compared time to first occurrence of a major adverse cardiovascular event (cardiovascular death, myocardial infarction, and stroke) between the intensive and standard BP treatment groups. Mean follow-up was 3.1 years; major adverse cardiovascular events was confirmed in 381 patients. Risk of major adverse cardiovascular events was significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio, 0.62; 95% CI, 0.40-0.96; P=0.03). Risks of all-cause and cardiovascular death in patients with resistant hypertension were also significantly lower in the intensive treatment group than in the standard treatment group (hazard ratio for all-cause death: 0.60; 95% CI, 0.38-0.97; P=0.03; hazard ratio for cardiovascular death: 0.34; 95% CI, 0.15-0.81; P=0.01). Similar associations were observed in various subgroups. Intensive BP treatment was significantly associated with a decreased risk of major adverse cardiovascular events in patients with resistant hypertension.