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Current hypertension guidelines lack personalized strategies for blood pressure control. While the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated benefits of intensive blood pressure lowering, identifying optimal candidates for such treatment remains challenging. We developed and validated a risk stratification model using data from 9139 SPRINT participants. The model incorporated 11 clinical variables through multivariable Cox regression analysis. Patients were stratified into low‐, medium‐, and high‐risk groups. The study protocol was registered at ClinicalTrials.gov (NCT01206062). The model showed good discrimination with C‐indices of 0.7354 (95% CI: 0.7065–0.7710) and 0.6894 (95% CI: 0.6545–0.7266) at 3 years for training and validation sets, respectively. Intensive treatment significantly reduced cardiovascular events in medium‐risk (3.17% vs. 5.11%, p = 0.0376) and high‐risk groups (9.34% vs. 11.86%, p = 0.0269), while showing a nonsignificant trend in the low‐risk group (2.87% vs. 3.34%, p = 0.0870). The Rank‐Weighted Average Treatment Effect analysis (16.06) supported potential benefits from individualized treatment allocation. No increased risk of severe adverse events was observed across risk groups. Our risk stratification model effectively identifies patients who derive significant cardiovascular benefits from intensive blood pressure lowering, particularly in medium‐ and high‐risk groups. This approach could guide more personalized hypertension management strategies.

BackgroundThis study explores the impact of intensive blood pressure (BP) control on left ventricular hypertrophy (LVH) incidence and evaluates the prognostic implications of LVH status (pre-existing/new-onset/persistent/regression) using Systolic Blood Pressure Intervention Trial (SPRINT) Electrocardiogram Data.MethodsPoisson regression was used to assess new-onset LVH and LVH regression rates. Multivariable-adjusted Cox proportional hazard models determined the risk of adverse cardiovascular events (ACE), a composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death, alongside safety adverse events.ResultsIn 8,016 participants, intensive BP control significantly reduced new-onset LVH (8.27 vs. 14.79 per 1000-person years; adjusted p<0.001) and increased LVH regression (14.89 vs. 11.89 per 1000-person years; adjusted p<0.001). Elevated ACE risk was notable in participants with pre-existing LVH [adjusted HR: 1.94 (95% CI: 1.25–2.99); p = 0.003], new-onset LVH [adjusted 1.74 (95% CI: 1.16–2.60); p = 0.007], and persistent LVH[adjusted HR: 1.96 (95% CI: 1.11–3.46); p = 0.020], compared to those without LVH. Intriguingly, LVH regression attenuated this risk increment [adjusted HR: 1.57 (95% CI: 0.98–2.53); p = 0.062]. Achieving a BP target of < 120/80 mmHg nullified the increased ACE risk in those with pre-existing LVH.ConclusionsIntensive BP control is instrumental in both reducing the emergence of LVH and fostering its regression. Pre-existing, new-onset LVH and persistent LV remain a predictor of adverse cardiovascular prognosis, whereas LVH regression and achieving on-treatment BP < 120/80 mmHg in pre-existing LVH individuals may further mitigate residual cardiovascular risk.Clinical trial registrationURL: ClinicalTrials.gov Unique Identifier: NCT01206062.

Background The Systolic Blood Pressure Intervention Trial-CKD substudy (SPRINT-CKD) has suggested a lower blood pressure (BP) target in CKD patients. However, it is questionable whether the SPRINT-CKD results may be generalized to CKD patients under nephrology care. Methods To compare SPRINT-CKD cohort versus referred CKD patients in terms of patients’ risk profile and outcomes, we pooled four prospective cohorts of consecutive CKD patients referred to 40 Italian renal clinics. We implemented the same inclusion/exclusion criteria adopted in SPRINT and same endpoints: (1) a composite of fatal and non-fatal cardiovascular (CV) events (2) all-cause mortality and (3) ESRD (composite of chronic dialysis, transplantation or 50% eGFR decline). Findings were compared with those attained in the control arm of SPRINT-CKD trial that mirrored standard BP management in clinical practice. Results Out of 2847 patients referred to renal clinics, only 20.1% (n = 571) were identified as eligible for SPRINT-CKD. Age (72 ± 9 years), gender (42.2% female) and systolic BP (142 ± 10 mmHg) did not differ from the SPRINT-CKD while referred patients had a worse risk profile at baseline: larger prevalence of prior CV disease (25.7% versus 19.5%), higher Framingham risk score (31.9 ± 14.6% versus 27.2 ± 24.7%) and lower GFR (38 ± 11 versus 48 ± 10 mL/min/1.73 m 2 ). During 4.0 years of follow-up, 86 CV events (50 fatal), 78 all-cause death and 59 ESRD occurred with annual incidence rates higher than those observed in the SPRINT-CKD control group (CV events 4.18 vs 3.19; all-cause death 3.64 vs 2.21; ESRD 2.80 vs 0.41%/year). Conclusions The SPRINT-CKD cohort is poorly representative of the CKD population under nephrology care, thus suggesting that conclusions may not apply to patients referred to nephrologist.

Frailty was found to be common in patients with atrial fibrillation/flutter (AF), but there was still a lack of evidence regarding the relationship between frailty and new-onset AF. We performed a analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT). In addition, we evaluated the relationship between baseline frailty status and new-onset AF in older adult patients with hypertension. In total, 7,316 participants were included in our analysis, and a total of 115 new-onset AF occurred during an average of 3.54 years of follow-up. Using SPRINT frailty index criteria, 1,535 fit, 4,041 less fit, and 1,740 frailty were enrolled. Compared with other groups, the incidence of new-onset AF in the frailty group was significantly higher. We constructed three Cox models to assess the relationship between the frailty status (fit group as reference) and new-onset AF. Participants with frailty had a significantly higher risk of new-onset AF compared with the fit group in all the models we used. We combined the fit group and the less fit group into a no frailty group to assess the impact of frailty on new-onset AF in various subgroups. After full adjustment (Model 3), frailty remained associated with the increased risk of new-onset AF compared with the no frailty group [hazard ratio [ ] = 2.09, :(1.41, 3.09), < 0.001]. Additionally, we examined the frailty index as continuous variable to assess the relationship between the frailty index and new-onset AF. The smooth curve showed that log HR appeared to increase linearly. And there was a significant interaction between baseline systolic blood pressure (SBP) categories and frailty on the risk of new-onset AF ( = 0.030). This study found baseline frailty status was a strong independent risk factor for new-onset AF among older adult patients with hypertension. Screening for frailty should be considered in older adult patients with hypertension to prevent new-onset AF.

The risks associated with non-albuminuric chronic kidney disease (CKD) have been investigated in diabetes mellitus but not in hypertensive patients. The objective of this study was to investigate the risks associated with non-albuminuric CKD in treated hypertensive patients in the Systolic Blood Pressure Intervention Trial (SPRINT) population. Based on baseline albuminuria status (urine albumin/creatinine ratio [UACR], ≥30 or <30 mg/g) and the levels of estimated glomerular filtration rate ([eGFR], ≥60, 45-59, or <45 mL/min/1.73 m ), participants were classified into six subgroups to assess the risks associated with the primary outcome and mortality. The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or mortality from cardiovascular causes. During a median follow-up of 3.26 years in 8,866 hypertensive patients, there were 352 deaths and 547 participants with the primary outcome. In adjusted Cox regression analysis using non-CKD and non-albuminuria (eGFR ≥60 mL/min/1.73 m combined with UACR <30 mg/g) as reference, albuminuria whether combined with CKD or not, showed significantly higher risk of both primary outcome and all-cause mortality in the total population. Whereas, non-albuminuria only combined with eGFR <45 mL/min/1.73 m showed significantly higher risk of both primary outcome and all-cause mortality in the intensive-therapy group. Non-albuminuric CKD did have higher risk of all-cause and CVD mortality only if the eGFR <45 mL/min/1.73 m . Increased albuminuria conferred higher risk of primary outcome and all-cause mortality irrespective the levels of eGFR. ClinicalTrials.gov, number: NCT01206062.

Background: The guidelines recommend intensive blood pressure control. Randomized trials have focused on the relevance of the systolic blood pressure (SBP) lowering, leaving the safety of the diastolic blood pressure (DBP) reduction unresolved. There are data available which show that low DBP should not stop clinicians from achieving SBP targets; however, registries and analyses of randomized trials present conflicting results. The purpose of the study was to apply machine learning (ML) algorithms to determine, whether DBP is an important risk factor to predict stroke, heart failure (HF), myocardial infarction (MI), and primary outcome in the SPRINT trial database. Methods: ML experiments were performed using decision tree, random forest, k-nearest neighbor, naive Bayesian, multi-layer perceptron, and logistic regression algorithms, including and excluding DBP as the risk factor in an unselected and selected (DBP < 70 mmHg) study population. Results: Including DBP as the risk factor did not change the performance of the machine learning models evaluated using accuracy, AUC, mean, and weighted F-measure, and was not required to make proper predictions of stroke, MI, HF, and primary outcome. Conclusions: Analyses of the SPRINT trial data using ML algorithms imply that DBP should not be treated as an independent risk factor when intensifying blood pressure control.

Previous studies found visit-to-visit heart rate variability (VVHRV) may be positively associated with risks of several cardiovascular events, but whether VVHRV affected the benefit of intensive blood pressure control remained unknown. In this study, we assessed the risk of the composite cardiovascular outcomes associated with VVHRV among the older patients with hypertension and evaluated whether the benefit of intensive blood pressure control in the prevention of the composite cardiovascular outcomes was consistent in the context of elevated VVHRV. This was a analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). We explored the relationship between VVHRV and the composite cardiovascular outcomes by multivariate Cox proportional hazard regressions. The primary endpoint was the composite cardiovascular outcomes, same as SPRINT, defined as a composite of myocardial infarction, stroke, heart failure, and/or death from cardiovascular causes. We used multiple adjustment models for all regressions. Nine thousand two hundred and fourty-seven patients from the SPRINT were included in our analysis. We found a positive association between VVHRV and the risk of composite cardiovascular outcomes among the elderly with hypertension. Per 1 CV increment in HRCV, the hazard ratio of the risk of composite cardiovascular outcomes was 1.04 (95CI: 1.03, 1.05) in the fully adjusted Model. The benefit of intensive blood pressure control in managing cardiovascular events was consistent in different VVHRV subgroups. There was no significant interaction in other confounders. We found the VVHRV was associated with the composite cardiovascular outcomes among the elderly with hypertension, intensive blood pressure control did not change the above association, and the benefits of intensive blood pressure management were consistent across different VVHRV groups.

Purpose of ReviewThe Systolic Blood Pressure Intervention Trial demonstrated significant decreases in cardiovascular events and total mortality with intensive systolic blood pressure lowering in adults with high cardiovascular risk in the absence of diabetes but benefits were accompanied by increased risk of adverse events.Recent FindingsOver 100,000 deaths and 46,000 cases of heart failure may be prevented annually if intensive systolic blood pressure lowering is implemented in 17 million US adults who are age 50 years and older, and have high cardiovascular risk in the absence of diabetes and meet eligibility for the Systolic Blood Pressure Intervention Trial. However, the benefits of intensive SBP lowering will be accompanied by an excess of 43,000 cases of electrolyte abnormalities and 88,000 cases of acute kidney injury.SummaryPhysicians should consider implementation of intensive systolic blood pressure lowering in appropriate patients who understand the risks and benefits of this intervention.

Introduction: The effect of Post-Activation Performance Enhancement (PAPE) has been investigated using various strength exercises and training equipment. Objective: This study aimed to assess the effect of dynamic strength exercises on unstable platforms on jump ability and linear speed in jumping athletes and university sprinters. Methodology: A randomized controlled crossover design was implemented with fifteen athletes from the University of Antioquia. All participants had at least six weeks of training experience, though variability in training years was considered a potential factor influencing results. The study lasted three weeks, with two randomized interventions. Participants initially completed three familiarization of strength exercises on unstable platforms. Pre-tests measuring 20-meter sprint and countermovement jump were then conducted. Two groups were formed: Group A performed a standard warm-up, while Group B completed three sets of eight repetitions of strength exercises on Bosu with two minutes of recovery. Post-tests were administered at 0, 5, 9, and 12 minutes after intervention. Following a seven-day washout period, groups switched protocols, and tests were repeated. A blinded statistical analyst used repeated measures ANOVA and post-hoc Tukey tests for comparisons, with graphical analysis conducted in R Studio. Results: Both protocols significantly improved countermovement jump and sprint performance (p < 0.001). However, the experimental group exhibited immediate sprint potentiation, whereas the control group experienced it at minute 9 (p < 0.001). Conclusions: Strength warm-ups on unstable platforms produce similar Post-Activation Performance Enhancement effects to stable dynamic warm-ups on neuromuscular variables such as countermovement jump and sprint.

Methods of blood pressure (BP) measurement aim to estimate the daily vascular load, which is theoretically resultant of the sum of heart beat-to-beat generated BP throughout 24 h. This chapter presents the evidences that automatic oscillometric methods are more precise than the auscultatory method for BP measurement. Methods for repeated and unwitnessed BP pressure measurements, such as in the automated office and home BP measurement, and in ambulatory BP measurement, are more efficient to estimate the usual BP. Clinical and complementary evaluation aim to assess target organ damage and stratify the risks of patients. Development of clinical disease assumes dominance in the determination of prognosis. ECG and echocardiogram, optic fundus examination, evaluation of aortic stiffness, peripheral artery disease, and BP variability are capable to further stratify the risks of patients, but do not influence the choosing of therapeutic strategies. Search of primary causes of hypertension is not indicated for most patients. Presence of diagnostic clues and resistant hypertension are the main reasons to search for primary causes of hypertension.