The effect of intensive treatment of hypertension on cardiovascular events, generalized to middle-aged to older Americans living with hypertension

The Systolic Blood Pressure Intervention Trial (SPRINT) estimated the effect of intensive systolic blood pressure treatment (target <120 mm Hg) compared to standard (<140 mm Hg) on the risk of cardiovascular events in adults aged 50 years and older. Clinical trial participants may differ from an intervention's target population. We generalized the SPRINT results to US adults who would qualify for treatment under SPRINT eligibility criteria. We applied these eligibility criteria to participants of the National Health and Nutrition Examination Survey (NHANES) from 2011-2018 to describe the target population. We estimated Cox proportional hazards models and Kaplan-Meier risk curves, weighted with the inverse odds of sampling, to estimate hazards ratios (HRs) and 5-year risk differences for the effect of intensive treatment on cardiovascular and adverse events in the target population. The HR for cardiovascular disease events was 0.76 (95% confidence interval [CI]: 0.53, 1.08) comparing intensive to standard treatment, which is consistent with the estimates from the original SPRINT trial. The 5-year risk difference for a cardiovascular event was $-$2.2% (95% CI: $-$5.3%, 1.6%). The HR for serious adverse events was 0.97 (95% CI: 0.83, 1.13). Despite differences between the SPRINT and target populations, we estimated a similar benefit of intensive treatment and similar rates of SAEs, in the target population.