Physicians' Academy for Cardiovascular Education

Intensive BP reduction beneficial for prevention of acute decompensated HF

Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial

Upadhya B, Rocco M, Lewis CE, et al, for the SPRINT Research Group - Circ Heart Fail. 2017;10:e003613


Hypertension is the most important risk factor for the development and the worsening of heart failure (HF) [1]. However, intensive blood pressure (BP)-lowering in HF patients has been associated with conflicting results, ranging from a 38% risk reduction of acute decompensated HF (ADHF) to significant increases of MACE outcomes, particularly at low diastolic blood pressure (DBP) values [2-4]. This may be due to different effects of intensive BP-lowering on various subgroups of patients, like for example the elderly, women or individuals of black race.

In this analysis of the SPRINT study, which was stopped early because of benefit in the intensive treatment arm on the primary outcome, the relative risk of developing ADHF was evaluated in the pre-specified subgroups. Moreover, the impact of intensive BP-lowering on ADHF and the predictors of incident ADHF were evaluated in these subgroups.

Main results


In all predetermined subgroups of patients at high risk for cardiovascular events in the SPRINT trial, targeting an SBP of <120 mmHg, as compared with <140 mmHg, significantly reduced the risk of developing ADHF by 36%. ADHF patients had a significantly higher risk for death and cardiovascular events. These findings highlight the importance of intensive BP reduction to prevent ADHF.


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Find this article online at Circ. Heart Fail.