Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort

Aims To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether effects varied by race/ethnicity. Materials and Methods We performed post-hoc analyses among Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic participants with and without MetS in the Systolic Blood Pressure Intervention Trial (SPRINT) randomized to a systolic blood pressure (SBP) target of less than 120 mm Hg (intensive group, N = 4544) or one less than 140 mm Hg (standard group, N = 4553). Median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction (MI), stroke, heart failure, non-MI acute coronary syndrome, or (CV) death. Results Overall, 3521/9097 (38.7%) of subjects met criteria for MetS at baseline. Baseline characteristics were similar between SBP groups within each MetS subgroup except BMI was slightly higher in the Standard arm of the MetS subgroup (33.3+/−5.6 vs. 33.0+/−5.3, p < 0.01) but similar across treatment arms in the non-MetS subgroup. The hazard ratio (HR) for the primary outcome was similarly reduced in subjects with or without baseline MetS (0.75 [95% CI 0.57, 0.96] and 0.71 [0.57, 0.87] respectively, adjusted p-value for treatment by subgroup interaction = 0.98). Similarly, there was no evidence of treatment by MetS subgroup interaction for all-cause mortality (adjusted interaction p value = 0.98). The findings were also similar across race/ethnic subgroups. Conclusions In this analysis the CV benefit of intensive SBP control did not differ among subjects by baseline MetS status, regardless of race/ethnicity.