The reduction in blood pressure required to reduce arterial stiffness components in SPRINT: A randomized controlled trial

Background: We previously demonstrated that intensive blood pressure (BP) control reduces total pulse wave velocity (T-PWV), through a load-dependent (LD-PWV), but not structural mechanism (S-PWV). We examined the extent to which changes in supine systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) influence T-PWV, S-PWV, and LD-PWV (per m/s) in participants enrolled in the SPRINT (Systolic Blood Pressure Intervention Trial). Methods: SPRINT was a multicenter randomized controlled trial that enrolled participants with baseline SBP ≥130 mmHg. Participants were randomized to intensive (SBP<120 mmHg) or standard (SBP<140 mmHg) BP interventions. We leveraged supine carotid-femoral PWV in a subset data from SPRINT-PWV ancillary (N=516). Our analysis examined the effect of changes in BP on changes in T-PWV, S-PWV, and LD-PWV over one year, adjusting for baseline covariates. Results: Decreases in SBP, DBP, and MAP were associated with reductions in T-PWV and LD-PWV (all p<0.001), but not S-PWV. Participants with reductions in T-PWV (≥1 m/s) had adjusted SBP, DBP, and MAP reductions that were 11.0, 5.4, and 7.2 mmHg greater, respectively, than participants who did not. For LD-PWV, progressively larger reductions in SBP, DBP, and MAP were observed across categories of LD-PWV change, with the greatest reductions occurring with LD-PWV decreases of ≥1.0 m/s. Conclusions: BP lowering significantly reduces T-PWV through LD-PWV, but not S-PWV. Clinically meaningful reductions in T-PWV were accompanied by reductions in LD-PWV, whereas changes in S-PWV were not associated with BP reduction. Further evaluation of existing or novel therapies to reduce S-PWV independent of BP modulation are needed.