Does mean systolic blood pressure less than 130 mm Hg ensure high rates of control to <140/<90 mm Hg? A cross-sectional analysis of two cohorts.

Objective: The purpose of this study was to determine how strongly mean systolic blood pressure (mSBP, mm Hg) was related to hypertension control and if an mSBP<130 was required to achieve ≥80% control to <140/<90.

Methods: mSBP and per cent control to <140/<90 at the last encounter were assessed in a cross-sectional analysis of two cohorts with hypertension: (1) randomised, controlled Systolic blood PRessure Intervention Trial (SPRINT) and (2) real-world American Medical Association's Measure Accurately, Act Rapidly, Partner with patients Hypertension programme. Methods: SPRINT randomised participants with hypertension to two SBP targets: <140 (standard treatment, SPRINT-S) and <120 (intensive treatment, SPRINT-I). MAP (Measure Accurately, Act Rapidly, Partner with patients) included adults with hypertension at five healthcare systems incentivised by payers to control BP to <140/<90. Methods: SPRINT participants with year 2 data. Patients in MAP (had hypertension, were aged≥18 years, had ≥2 healthcare visits from November 2019 through October 2021 and received care from clinicians (n=544) with ≥24 patients. Methods: mSBP and control to <140/<90. In MAP, control to <140/<90 was assessed in clinicians grouped by 5 mm Hg increments in the mSBP of their patient panel.

Results: In SPRINT-S (n=4303) and SPRINT-I (n=4323), mSBP values at the last visit were 136.7 and 121.7 with BP<140/<90 in 61% and 88% of participants, respectively. In MAP, mSBP at the last visit (n=168 978 patients) was 132.1 with BP<140/<90 in 70% of participants. Among clinicians with participant mSBP of 120 to <125, 88% of their patients were controlled to <140/<90, similar to SPRINT-I. Control fell to 79% of patients, with clinician-level mSBP of 125 to <130, 71%, with mSBP of 130 to <135 and 57%, with mSBP of 135 to <140 (similar to SPRINT-S); mSBP accounted for 80% of variance in clinician-level hypertension control.

Conclusions: mSBP is strongly related to hypertension control. Moreover, mSBP<130 is required to attain control rates to <140/<90 in the range of 80% and higher.