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Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics.

Publication ,  Journal Article
Upadhya, B; Lovato, LC; Rocco, M; Lewis, CE; Oparil, S; Cushman, WC; Kostis, JB; Rodriguez, CJ; Cho, ME; Cloud, LW; Rastogi, A; Rosendorff, C ...
Published in: JACC Heart Fail
December 2019

OBJECTIVES: This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study. BACKGROUND: SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications. METHODS: Detailed use of medication data prospectively collected throughout the trial were examined. RESULTS: ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83). CONCLUSIONS: No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2019

Volume

7

Issue

12

Start / End Page

1032 / 1041

Location

United States

Related Subject Headings

  • Single-Blind Method
  • Prospective Studies
  • Middle Aged
  • Hypertension
  • Humans
  • Heart Failure
  • Diuretics
  • Aged, 80 and over
  • Aged
  • Acute Disease
 

Citation

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Upadhya, B., Lovato, L. C., Rocco, M., Lewis, C. E., Oparil, S., Cushman, W. C., … SPRINT Research Group, . (2019). Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics. JACC Heart Fail, 7(12), 1032–1041. https://doi.org/10.1016/j.jchf.2019.08.018
Upadhya, Bharathi, Laura C. Lovato, Michael Rocco, Cora E. Lewis, Suzanne Oparil, William C. Cushman, John B. Kostis, et al. “Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics.JACC Heart Fail 7, no. 12 (December 2019): 1032–41. https://doi.org/10.1016/j.jchf.2019.08.018.
Upadhya B, Lovato LC, Rocco M, Lewis CE, Oparil S, Cushman WC, et al. Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics. JACC Heart Fail. 2019 Dec;7(12):1032–41.
Upadhya, Bharathi, et al. “Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics.JACC Heart Fail, vol. 7, no. 12, Dec. 2019, pp. 1032–41. Pubmed, doi:10.1016/j.jchf.2019.08.018.
Upadhya B, Lovato LC, Rocco M, Lewis CE, Oparil S, Cushman WC, Kostis JB, Rodriguez CJ, Cho ME, Cloud LW, Rastogi A, Rosendorff C, Kitzman DW, SPRINT Research Group. Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction: Potential Role of Diuretics. JACC Heart Fail. 2019 Dec;7(12):1032–1041.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

December 2019

Volume

7

Issue

12

Start / End Page

1032 / 1041

Location

United States

Related Subject Headings

  • Single-Blind Method
  • Prospective Studies
  • Middle Aged
  • Hypertension
  • Humans
  • Heart Failure
  • Diuretics
  • Aged, 80 and over
  • Aged
  • Acute Disease