The Role of Intensive Blood Pressure Management in Reducing Cardiovascular Events: A Prospective Cohort Study
Description
Introduction Hypertension is a major global health issue, contributing significantly to cardiovascular morbidity and mortality. Although advancements in antihypertensive treatments have been made, there is still debate about the optimal blood pressure target to reduce cardiovascular events. The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated the benefits of intensive blood pressure (BP) control, but questions remain about its long-term effects and its applicability to broader patient populations. Objectives This study aims to evaluate the effectiveness of intensive BP management in reducing major cardiovascular events (MACE) compared to standard BP management, while identifying specific subgroups of patients (based on age, comorbidities, and cardiovascular risk) who benefit most from intensive control. Methods A prospective, multicenter cohort study was conducted over five years (2018–2023) in multiple countries, enrolling 3,000 hypertensive patients aged 40-75 years. Patients had no history of cardiovascular events at baseline, with inclusion criteria being a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg. Key exclusion criteria were secondary hypertension, recent cardiovascular events, and severe comorbidities. Results At baseline, participants had an average age of 60.4 years, with 52% male, and both groups were well-matched for risk factors such as smoking, diabetes, and hyperlipidemia. After five years, the incidence of MACE was significantly lower in the intensive BP management group (8.5%) compared to the standard group (12.3%), with notable reductions in myocardial infarction (2.1% vs. 4.0%), stroke (3.2% vs. 4.5%), and cardiovascular death (2.5% vs. 3.8%). Subgroup Analyses The most significant benefits of intensive BP control were observed in patients aged 60 or older, those with diabetes, and individuals with higher baseline cardiovascular risk. Discussion This study demonstrates that intensive BP management significantly reduces cardiovascular events, particularly in high-risk populations, aligning with findings from the SPRINT trial but extending the evidence to a broader population. While the benefits of intensive BP control are clear, the risks of adverse events, such as hypotension and electrolyte disturbances, must be considered and managed carefully. Future research should focus on optimizing strategies to identify patients who will benefit most from aggressive BP control without increasing the risk of adverse events. Conclusion The study confirms that intensive BP management reduces cardiovascular events in hypertensive patients, with the greatest benefit observed in high-risk populations. Personalized treatment approaches are recommended to maximize benefits while minimizing risks.