Abstract 4146636: Intensive Hypertension Management and Incident Heart Failure Risk for Blacks versus Non-Blacks: Insights From SPRINT

Background: Despite advances in blood pressure (BP) management, Black individuals continue to have disparate rates of uncontrolled hypertension and its sequelae, including heart failure (HF). The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated lower risk of cardiovascular diseases (CVD), including HF, among high-risk, hypertensive adults randomized to intensive (systolic BP [SBP] target <120 mmHg) vs. standard (SBP target <140 mmHg) BP control. Research Question: We asked if Black hypertensive adults in SPRINT had a higher risk of developing HF compared to non-Black adults and if intensive BP control reduced this risk. Aim: We aimed to highlight the disproportionate risk of HF in Black vs. non-Black individuals and the need for more intensive BP control in this population. Methods: The SPRINT participants were categorized by race into Black and non-Black groups, the latter incorporating non-Hispanic Whites, Hispanics, Indians, Hawaiians, Asians, and others. Cox proportional hazards regression models assessed the risk of incident HF adjusted for potential confounders, including age, sex, body mass index, subclinical CVD, smoking, SBP, number of anti-hypertensives, total cholesterol, aspirin use, statin use, estimated glomerular filtration rate, and BP treatment arm. Interaction testing assessed whether the effect of the BP treatment arm on incident HF risk differed by race. ARR was calculated as the difference in incident HF rates between the standard and intensive BP control groups for each racial group. Results: Of the 9,361 SPRINT participants, 31% identified as Black and 69% non-Black. Fully adjusted Cox regression analysis revealed increased risk of incidental HF among Black vs. non-Black participants (HR 1.45, 95% CI 1.05-2.00, p=0.002). There was no significant interaction between race and BP treatment arm for incident HF (p=0.79). Similar non-significant risk reduction with intensive vs. standard BP control was seen for Black (HR 0.78, 95% CI 0.47-1.31, p=0.35) and non-Black (HR 0.80, 95% CI 0.58-1.10, p=0.17) participants; however, ARR in incident HF was greater in Black (4.2%) vs. non-Black (3.1%) participants. Conclusion: Black participants had a higher risk for incident HF than non-Black participants. Despite similar relative risk reduction with intensive BP control by race, Black participants had higher ARR than non-Black participants, indicating potentially higher benefits with intensive BP control in Black individuals.