The SPRINT (Systolic Blood Pressure Intervention Trial) study reported that intensive blood pressure (BP) treatment with a systolic BP target of <120 mm Hg decreased the risks of cardiovascular events. However, it remains unknown whether specific medications can further improve cardiovascular outcome in patients receiving intensive BP treatment. This study examined whether
thiazide use improves cardiovascular outcome in patients receiving intensive BP treatment. We used data of nondiabetic patients receiving intensive BP treatment in the SPRINT study. The primary outcome was a composite end point of
myocardial infarction,
acute coronary syndrome,
stroke,
heart failure, or cardiovascular death. We analyzed hazard ratios for outcomes with 95% CIs in patients taking
thiazides compared with those not taking
thiazides using Cox proportional hazard models. This study included 2847 patients and the mean follow-up period was 3.3 years. The risk of primary outcome events was significantly lower in patients taking
thiazides than in those not taking
thiazides in both entire and propensity score-matched cohorts. Particularly,
heart failure risk was significantly lower in those taking
thiazides. These associations were also observed in various subgroups. In addition,
thiazide use was associated with decreased risk of all-cause mortality.
Hypokalemia occurred more frequently in patients taking
thiazides than in those not taking
thiazides.
Thiazide use decreased risk of cardiovascular events, particularly
heart failure, in nondiabetic high-risk patients receiving intensive BP treatment.